Liangge San: Cooling-Ge Powder to Drain Fire and Free the Bowels

Liangge San comes from Tai Ping Hui Min He Ji Ju Fang (Formulary of the Taiping Imperial Pharmacy). It consists of Chuan Dahuang (Sichuan rhubarb), Puxiao (mirabilite), and Zhi Gancao (honey-fried licorice) each 20 liang (600 g), Zhiren (gardenia fruit), Bohe (peppermint, stems removed), and Huangqin (scutellaria) each 10 liang (300 g), and Lianqiao (forsythia) 2.5 jin (1250 g). At use, powder all the above; each time take 2-4 qian (6-12 g), add 3 g of bamboo leaves and a little honey, and decoct in water.

This formula drains fire and frees the bowels, clears the upper and drains the lower. It treats constraint of evil qi generating heat in the upper and middle burners, presenting as vexation and thirst, red face and parched lips, heat and stuffiness in the chest and diaphragm, mouth and tongue ulcers, restless sleep, delirium and mania, or sore throat with vomiting/nosebleed, constipation with dark urine, or difficult defecation; a red tongue with yellow coating and a slippery, rapid pulse. Today it is often used for lobar pneumonia, fever, and insomnia. Modern pharmacology shows Liangge San inhibits NF-kB activity in mouse tissues damaged by endotoxin, thereby suppressing the production of various inflammatory cytokines and protecting the body.

Liangge San is built on Tiaowei Chengqi Tang (Regulate-the-Stomach Order-the-Qi Decoction, made of rhubarb, mirabilite, and honey-fried licorice; puxiao is the crude product of mirabilite), plus heat-clearing gardenia, scutellaria, bamboo leaves, forsythia, and peppermint. Tiaowei Chengqi Tang comes from Shang Han Lun (Treatise on Cold Damage) and belongs to TCM's purgative formulas, but as a mild purgative. It treats "cold damage with no aversion to cold but aversion to heat, with delirium more than ten days after the channel course." In TCM this is classified as the Yangming disease of gastrointestinal dryness-heat; such patients often have constipation, thirst and vexation, steaming fever, abdominal distention, clouded spirit, vomiting/nosebleed, sore swollen throat, and mouth/tongue ulcers.