Kuanqi Wan: Expelling Phlegm and Dispelling Fluid, Downbearing Qi to Stop Wheezing
In "Shengji Zonglu" (Imperial Benevolent Records) there is a formula called Kuanqi Wan. Its composition is: Fangji (Stephania tetrandra) and Tian Tingli (descurainia seed, stir-fried with paper separating), each five qian (now 15 g); Hei Qianniuzi (black pharbitis seed, stir-fried until fragrant), one liang (now 30 g). Preparation: grind the three herbs into a fine powder, blend with boiled honey to make pills the size of a parasol-tree seed. Dosage: take 20 pills each time, washed down with a concentrated decoction of Sangbaipi (Morus root bark) after meals and before bed. This formula's actions are to expel phlegm and drain fluid, downbear qi and calm wheezing. It treats phlegm-fluid lodged in the lung, leading to upward rushing panting, thick sticky nasal discharge and sputum, and conditions that do not resolve over time.
These symptoms are commonly seen in asthma and in terminal-stage tumor patients with pleural effusion. The four herbs used—Fangji, Tian Tingli (i.e., Tinglizi/descurainia seed), Qianniuzi (pharbitis seed), and Sangbaipi—all drain lung excess and calm wheezing.
Fangji here should be Han Fangji (Han nomenclature); among the various "fangji" species, Han Fangji has the best fluid-draining and swelling-reducing action, and is also the least toxic and safest. Its main actions are to dispel wind-dampness, relieve pain, and drain water; it treats wind-damp bi pain, edema, ascites, beriberi swelling, and difficult urination. Han Fangji is especially good for lung diseases; tetrandrine tablets extracted from it are also used clinically for lung cancer and for rheumatic, arthritic, and neuralgic pain.
Tinglizi's main action is to drain lung excess, calm wheezing, and drain water and reduce swelling; it treats cough and panting from phlegm obstructing a replete lung, edema with scanty urine, and difficult urination. Stir-frying with paper mainly removes oil; the paper used should be the old, oil-absorbing straw paper. Sangbaipi likewise drains lung excess, calms wheezing, drains water, and reduces swelling; it treats cough and panting with abundant phlegm due to lung heat, edema with scanty urine, and difficult urination.
Tinglizi is often combined with Sangbaipi; the pair's main action is to drain lung excess, calm wheezing, drain water, and reduce swelling. In this formula, Sangbaipi is decocted to a liquid used to wash down pills made from the other three herbs. One may also decoct 1-2 liang of Sangbaipi and mix it with the other herb powders to form water-honey pills, taken directly without needing a separate decoction.
Qianniuzi comes in black and white varieties; this formula uses the black one. "Zhenglei Bencao" says of Qianniuzi: "It mainly downbears qi, treats foot fullness and edema, expels wind toxin, and frees urination." "Bencao Yidu" says: "It specifically resolves edema, most effectively frees the two bowel routes; relieves all qi congestion and expels every kind of phlegm-fluid." Qianniuzi's main actions are purgative, water-expelling, stagnation-removing, and insect-killing. It treats edema, tympanites, phlegm-fluid wheezing and cough, gastrointestinal damp-heat stagnation, constipation, and abdominal pain from worm accumulation.
In TCM, Qianniuzi is a harsh purgative and diuretic; it is toxic. Excessive dosage not only directly irritates the gastrointestinal tract, causing vomiting, abdominal pain, diarrhea, and mucus-bloody stools, but also damages the kidneys, causing hematuria; in severe cases it may injure the nervous system, leading to coma and speech disturbance. Therefore weak patients and pregnant women must not use it. In this formula, Qianniuzi has the largest dosage, so safety must be observed. Stir-frying it until fragrant is precisely to reduce its toxicity.
Overall, this is a very good prescription for abundant phlegm and pleural effusion caused by asthma, lung cancer, or other tumors, but safety must be observed in use. For weak patients, I suggest following the model of Tingli Dazao Xiefei Tang: decoct 10 jujubes and use the broth to wash down Kuanqi Wan. Also, do not start at 20 pills; begin with 5 pills. If the patient tolerates it without adverse effects, gradually increase by 1-2 pills each time until effective.