Indications for Chaihu Xianxiong Decoction
Chaihu Xianxiong Tang comes from the *Revised Popular Treatise on Cold-Damage* (Chongding Tongsu Shanghan Lun). Its composition is: 3g of bupleurum root (Chaihu, 1 qian), 9g of ginger-processed pinellia (Jiang Banxia, 3 qian), 2.4g of Coptis rhizome (Xiao Chuanhuanglian, 4 fen), 3g of platycodon root (Ku Jiegeng, 1 qian), 4.5g of scutellaria root (Huangqin, 1 qian 5 fen), 15g of trichosanthes seed (Gualouren, 5 qian), 4.5g of immature bitter orange (Xiao Zhishi, 1 qian 5 fen), and 4 drops of fresh ginger juice (taken in two divided doses). Decoct the above in water; take one dose daily, divided into two servings.
This formula has the actions of harmonizing and resolving, clearing heat, expelling phlegm, and broadening the chest. It is mainly indicated for pathogen entrapped in Shaoyang with phlegm-heat binding in the chest (jiexiong syndrome), presenting with alternating chills and fever, fullness and oppression in the chest and hypochondrium that hurts on pressure, nausea and inability to eat, bitter and sticky mouth, dizziness, or cough with thick sputum, yellow greasy tongue coating, and wiry, slippery, rapid pulse. Today it is often used for pleurisy, gallstones, angina pectoris, reflux esophagitis, and pleural effusion (thoracic fluid).
Chaihu Xianxiong Tang is a modified combination of Xiao Chaihu Tang and Xiao Xianxiong Tang, so it has the actions of both. Xiao Chaihu Tang is the representative formula for treating Shaoyang syndrome of alternating cold and heat with bitter mouth and dizziness; Xiao Xianxiong Tang is the representative formula for treating the binding chest syndrome of fullness and oppression below the heart. Used together, they treat both the Shaoyang pattern of alternating cold and heat, bitter mouth, and dizziness, and the phlegm-heat binding chest pattern of epigastric fullness.
The above presentation is a common pathological phenomenon. Among digestive diseases, reflux esophagitis, gastritis, cholecystitis, and gallstones; among respiratory diseases, pleurisy, pleural mesothelioma, and advanced lung cancer; among circulatory diseases, angina pectoris—all may present with these symptoms. According to the TCM principle of treatment based on pattern differentiation, as long as the patient's symptoms match the Chaihu Xianxiong Tang pattern, Chaihu Xianxiong Tang may be used.
If the patient also has constipation, add cistanche (Roucongrong), rhubarb (Dahuang), and hemp seed (Huomaren) to the base formula. For patients with pleural effusion, appropriately add descurainia/tingli seed (Tinglizi), mulberry bark (Sangbaipi), Poria (Fuling), Polyporus (Zhuling), plantago seed (Cheqianzi), Achyranthes root (Huai Niuxi), and waxgourd seed (Dongguaren). For angina patients, add cinnamon twig (Guizhi), macrostem onion (Xiebai), salvia (Danshen), and sandalwood (Tanxiang). For reflux esophagitis or gastritis with severe nausea and vomiting, add bamboo shavings (Zhuru), processed arisaema (Dannanxing), tangerine red (Juhong), ochre (Daizheshi), inula flower (Xuanfuhua), and loquat leaf (Pipaye). For severe epigastric pain, appropriately add corydalis (Yuanhu), trogopterus dung (Wulingzhi), and cattail pollen (Puhuang).