Indications of Mahuang Lianqiao Chixiaodao Tang
Mahuang Lianqiao Chixiaodao Tang (Ephedra, Forsythia, and Rice Bean Decoction) is a classical formula from Zhang Zhongjing's Treatise on Cold Damage (Shanghan Lun). Its composition is: 6g of Ephedrae Herba (Mahuang, nodes removed), 6g of Forsythiae Fructus (Lianqiao), 40 pieces of Armeniacae Semen (Xingren, peel and tip removed), one sheng of Phaseoli Calcarati Semen (Chixiaodao), 12 Jujubae Fructus (Dazao), one sheng of Cortex Catalpae Ovatae Albae (Sang Baipi; sliced; modern use is mostly 15–30g), 6g of Zingiberis Rhizoma Sheng (Shengjiang), and 6g of Radix Glycyrrhizae Praeparata (Zhi Gancao). One Han-dynasty liang is about 15g today, but for safety it is now converted to 3–5g. Article 262 of the Treatise on Cold Damage: "In cold damage, if static-heat is interior, the body must become yellow; Mahuang Lianqiao Chixiaodao Tang governs." Zhang Zhongjing held that this formula treats jaundice caused by static-heat in the interior.
Nearly all the formulas containing Ephedra in the Treatise on Cold Damage require first decocting the Ephedra, skimming off the foam, then adding the other herbs and decocting together; this formula is no exception. The original text states: "The above eight herbs are boiled in one dou of rainwater; first boil the Ephedra, and when it has boiled twice, skim off the foam on top, add the other herbs, and boil to three sheng, remove the dregs, and take warm in three divided doses, finishing within half a day."
Note that the above dose is for half a day, divided into three doses within half a day. Modern people have grown accustomed to taking herbal decoction twice a day, morning and evening, but in Zhang Zhongjing's time, treating disease was not so mechanical. Some decoctions, in order to achieve the desired effect, used larger amounts and more frequent dosing than today.
Judging from the composition of Mahuang Lianqiao Chixiaodao Tang, the formula contains the acrid-wind-releasing Ephedra and fresh Ginger, as well as Cortex Mori Albae (Sang Baipi), which calms wheezing and reduces swelling; Forsythia (Lianqiao), which clears heat and resolves toxin; Apricot Kernel (Xingren), which stops cough and calms wheezing; Rice Bean (Chixiaodao), which promotes diuresis and reduces swelling; processed Licorice (Zhi Gancao), which stops cough and expels phlegm; and Jujube (Dazao), which harmonizes the flavors. When these herbs are combined, they promote diuresis and reduce swelling, stop cough, and calm wheezing. Therefore it mainly treats diseases that have both a cold-damage exterior pattern (aversion to cold, absence of sweating) and a damp-excess edema pattern (jaundice, body swelling). Usually such patients may also have symptoms such as itching and easy skin dermographism. Modern use may include nephritic edema, chronic urticaria, dermatographism, nephritic purpura, chronic obstructive pulmonary disease, asthma, and tracheitis, in patterns of damp-heat with exterior contraction and jaundice.
On the basis of this formula, Professor He Ren also created a formula specifically for chronic urticaria: Ephedra 5g, Forsythia 9g, Rice Bean 15g, sesame seed (or black sesame) 30g, Fallopia multiflora (Heshouwu) 9g, Sophora flavescens (Kushen) 6g, Acorus tatarinowii (Shichangpu) 6g, Licorice 5g. The author has used the original Mahuang Lianqiao Chixiaodao formula to treat urticaria matching this formula's pattern, and the original formula alone works very well. I also saw a case treated by Professor Liu Duzhou of a urticaria patient with generalized itching, also using the original formula. This shows that Mahuang Lianqiao Chixiaodao Tang itself has some efficacy in treating urticaria; Professor He Ren's empirical formula certainly also has its own unique experience, and both can be tried clinically.
Ephedra, Forsythia, Cortex Mori Albae, Rice Bean, fresh Ginger, and Jujube all have a diuretic action, so the diuretic power of this formula is quite strong. This formula also has a certain efficacy for nephritic edema, pulmonary edema, and pleural effusion in cancer patients. In the author's experience, the various diseases treated by this formula all share the disease mechanism summarized by Tsumura Fumihiro as the body's own "water-intoxication syndrome." Patients usually have facial puffiness, swollen eyelids, and pressing the skin on the lower legs leaves an indentation that does not rebound quickly; some patients also have difficulty urinating.
But Ephedra must be used carefully. Some patients become easily excited or allergic after taking Ephedra, with elevated blood pressure and even nosebleeds. Ephedra became a controlled drug many years ago and cannot be sold in some pharmacies in Beijing. Therefore, when using this formula, one must follow the TCM principle of "if the pattern is present, use the medicine"; without the corresponding symptoms, this formula is strictly prohibited.
As long as the formula matches the pattern, do not be bound by the dogma of "do not use Ephedra in spring and summer"; Ephedra can be used in any season. The author recently treated a patient who had drowned in childhood and had long-standing nasal obstruction as an adult, and used Mahuang Tang (Ephedra Decoction) with some effect. Therefore in the height of summer, when Ephedra should be used, it must be used without being bound.