Five Modified Formulas of the Famous Phlegm-Resolving Erchen Tang

Doctor zhou
Erchen Tang (Two-Aged Decoction) comes from the Taiping Huimin Heji Jufang (Formulas from the Imperial Grace Pharmacy). It is composed of Banxia (Pinellia), Juguhong (Tangerine Red), Bafuling (White Poria), Zhigancao (honey-fried Licorice), Shengjiang (Fresh Ginger) and Wumei (Mume). It dries dampness and resolves phlegm, and fortifies the spleen and harmonizes the center; it is a commonly used TCM formula for phlegm-fluid disease, and is now often used for acute episodes of chronic bronchitis, hyperlipidemia, chronic gastritis and migraine. Modern pharmacology shows Erchen Tang has antitussive, phlegm-resolving, anti-asthmatic and digestive actions, as well as antioxidant, anti-aging and lipid-lowering effects.
Erchen Wan (Two-Aged Pill), made from the Erchen Tang prescription, is sold on the market. I previously wrote an article titled The Damp-Dispelling, Phlegm-Resolving Good Formula Erchen Wan introducing this formula, so I will not repeat it here.
For a famous formula such as Erchen Tang, many famous physicians through history made modifications on this basis, composing various modified Erchen formulas to expand its treatment range. I have previously written about Maxing Erchen Tang (see my article Two Case Reports of Maxing Erchen Tang), Kaiyu Erchen Tang (see my article Kaiyu Erchen Tang, Which Activates Blood and Resolves Stasis, Resolves Phlegm and Disperses Nodules, and Spreads Liver Qi and Resolves Constraint), and Lingzhu Erchen Tang (see my article Lingzhu Erchen Tang, a TCM Formula That Treats Gastric Retention).
Erchen Tang or Erchen Wan works very well for nausea and vomiting caused by cancer radiotherapy and chemotherapy. I myself use Erchen Tang and its modified formulas very often, and I am repeatedly impressed by their efficacy. This article introduces five more modified Erchen formulas: Erzhu Erchen Tang, Erchen Mutong Tang, Erchen Pingwei San, Erchen Xionggui Tang, and Chaihu Guizhi Erchen Tang. The first four are empirical formulas used by other physicians in history; the fifth is my own empirical formula.
Erzhu Erchen Tang comes from the Gujin Yitong (Comprehensive Medical Compendium of Ancient and Modern Times). It is also called Cangbai Erchen Tang (the name used in the Yilue Liushu). The formula consists of Cangzhu (Atractylodes, stir-fried with earth), Baizhu (White Atractylodes, stir-fried with earth), Banxia (Pinellia, soaked seven times in boiling water and ginger-processed), Chenpi (Tangerine peel, white removed), and Fuling (Poria), each one qian (3 g), plus Zhigancao (honey-fried Licorice) five fen. Decoct in water with three slices of ginger and one jujube. This formula treats spleen qi deficiency with phlegm-damp internal obstruction and vomiting of clear fluid; it also treats phlegm-damp headache with a wiry, fine pulse. For deficiency-cold, add Renshen (Ginseng) and Weiganjiang (roasted Dried Ginger); for phlegm-fluid, add Tiannanxing (Arisaema) and double the Banxia; for undigested food accumulation, add Shenqu (Medicated Leaven) and Sharen (Amomum).
Erzhu Erchen Tang works well for acid regurgitation, vomiting of clear fluid and indigestion caused by chronic gastritis, and also for phlegm-damp type hyperlipidemia. Adding Tiannanxing, Zhuru (Bamboo shavings) and Shichangpu (Acorus) to this formula has some effect on nausea and vomiting in stroke or brain tumor patients.
Erchen Mutong Tang also comes from the Gujin Yitong and is an empirical formula of Zhu Danxi. It consists of Chenpi (Tangerine peel) one qian (3 g), Fabanxia (processed Pinellia) eight fen (2.4 g), Zhigancao four fen (1.2 g), Mutong (Akebia) and Huashi (Talc) each one qian (3 g), and Renshen lutou (Ginseng rhizome) one qian five fen (4.5 g). Grind these into coarse powder, add three slices of ginger and one jujube, and decoct in 200 ml of water down to 160 ml for use.
Zhu Danxi used this formula to treat TCM guan-ge disease, which is what we call intestinal obstruction today: patients cannot pass urine or stool, and cannot eat or drink. Erchen Mutong Tang resolves phlegm and moves qi, induces vomiting and unblocks the bowels. After taking it, patients vomit, and then urine and stool pass freely. This formula has some effect on incomplete intestinal obstruction.
Erchen Pingwei San comes from the Bing Yin Mai Zhi (Treatment of Disease According to Cause, Symptom and Pulse), also called Pingwei Erchen San. It consists of Fabanxia and Bafuling each two qian (6 g), Gancao (Licorice) one qian (3 g), and Cangzhu and Houpo (Magnolia bark) each two qian (6 g). This formula fortifies the spleen and resolves food stagnation, resolves phlegm and dries dampness; it can treat cough from food accumulation. Patients cough at the fifth watch before dawn, coughing until morning; the sputum tastes sweet; the chest and abdomen are full and bloated; diarrhea comes and goes, or the stool is jelly-like; there are borborygmi; and there is stabbing pain in both hypochondria.
This formula works very well for cough and wheezing caused by reflux esophagitis or gastroenteritis. In TCM view this disease belongs to spleen deficiency with damp excess and untransformed phlegm-fluid; treatment should combine spleen fortification with phlegm resolution. This formula combines Erchen Tang with Pingwei San, hence the name Erchen Pingwei San. Erchen Tang resolves phlegm and Pingwei San fortifies the spleen; together they provide good symptomatic treatment for cough and wheezing caused by reflux esophagitis or gastroenteritis.
Erchen Xionggui Tang comes from the Yixue Rumen (Introduction to Medicine). It consists of Banxia, Chenpi, Chifuling (Red Poria), Gancao, Renshen (Ginseng), Ejiao (Donkey-hide Gelatin), Wuweizi (Schisandra) and Xixin (Asarum), each five fen (1.5 g); Baishao (White Peony), Chuanxiong (Ligusticum) and Danggui (Angelica) each one qian (3 g). Decoct in water with an appropriate amount of ginger. Decoct two doses daily, taken warm after meals.
This formula treats cough with blood-streaked sputum caused by taxation fatigue with blood deficiency, internal consumption of fluids, and heart fire flaring upward to the lung, as well as blood failing to nourish the skin with susceptibility to chills and cough at the slightest exertion. This disease is mostly seen in people with low immunity and yin deficiency with effulgent fire, who catch repeated colds; once they catch cold they cough for a long time, and may even cough blood. Xixin in this formula is hepatotoxic; it can be replaced by an equal amount of Ganjiang (Dried Ginger) or Zisu (Perilla).
Chaihu Guizhi Erchen Tang is a self-created formula of mine, combining Chaihu Guizhi Tang with Erchen Tang. The formula is as follows: Chaihu (Bupleurum) 10-24 g, Guizhi (Cinnamon twig) 10 g, Baishao (White Peony) 10 g, Huangqin (Scutellaria) 10 g, Zhigancao (honey-fried Licorice) 6 g, Dangshen (Codonopsis) 15-30 g (use Renshen 6-10 g for the weak or elderly), Chenpi (Tangerine peel) 10 g, Fabanxia (processed Pinellia) 10 g (replace Fabanxia with Tianhuafen if the mouth is dry), Wumei (Mume) 10 g, Fuling (Poria) 10 g, Shengjiang (Fresh Ginger) 10-30 g, Dazao (Jujube) 3-7 pieces. Decoct in water; one dose daily, taken after breakfast, lunch and dinner.
This formula is used for patients with fever, aversion to cold, cough and abundant phlegm after viral infection. It can also be used for chronic bronchitis patients with incessant cough and wheezing, abundant phlegm and aversion to cold but without fever.
Abundant phlegm is one of the clinical symptoms of many diseases. For some phlegm conditions whose cause is unclear, or whose cause is clear but treatment is difficult, treating with Erchen Tang and its modified formulas often achieves good results. As I have repeatedly emphasized, the key to treating disease in TCM is symptomatic treatment (what TCM calls pattern differentiation and treatment). For many phlegm-producing diseases, as long as we grasp the main and accompanying symptoms and treat according to the corresponding TCM formula, there is always some effect.

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