Veteran TCM Physician Ling Yunpeng's Empirical Formula Quyuan Tang for Purulent Nasal Discharge
Ling Yunpeng was a veteran TCM physician in China who mastered both internal medicine and external medicine. Dr. Ling inherited the family tradition of external medicine from childhood and practiced for more than thirty years with rich experience. He believed that “the practice of external medicine must be grounded in the principles of internal medicine.” In the 1970s he spent “eight years in internal medicine and five years studying herbal medicine,” and “successfully treated many critical, life-threatening cases.” In his later years he wrote his lifetime of clinical experience into the book Linzhen Yide Lu (Notes on Clinical Gains), which contains many effective formulas passed down from his family or worked out by himself. A reader pointed out that this formula originates from Bianzheng Lu (Records of Pattern Differentiation); thank you for the correction.
Quyuan Tang (Yielding-the-Deep-Spring Decoction) is one of them. Its composition is: Xinyi (Magnolia flower) 6 g, Danggui (Angelica sinensis) 9 g, Shanzhi (Gardenia) 9 g, Chaihu (Bupleurum) 3 g, Beimu (Fritillaria) 3 g, Xuanshen (Scrophularia) 30 g. Decoct in water, take once in the morning and once in the evening. Dr. Ling used it to treat “biyuan” (nasal-source syndrome) characterized by thick purulent nasal discharge. This condition corresponds to what is today called rhinitis and sinusitis; most patients with nasopharyngeal carcinoma also have these symptoms. The formula can treat both rhinitis and sinusitis, and can relieve the nasal congestion and purulent discharge of nasopharyngeal carcinoma patients, though when used for nasopharyngeal carcinoma it must be combined with other formulas and herbs.
Dr. Ling's formula has the effect of clearing fire and benefiting the brain. The reason Xuanshen is used in a heavy dose is that it clears heat and cools the blood, nourishes yin and downbears fire, and resolves toxins and dissipates nodules. Biyuan is mostly a chronic course, and neither Chinese nor Western medicine has a specific therapy. Many patients who develop it never recover; over time, the nasopharyngeal region shows varying degrees of inflammatory changes, swelling and deformity. Modern pharmacological research has found that Xuanshen inhibits various inflammatory responses, so using it heavily in this formula serves to clear heat, downbear fire, and reduce inflammation and swelling.
Xinyi disperses wind-cold and unblocks the nasal orifices; it is the specific TCM herb for treating nasal congestion and discharge, and also treats the headache caused by nasal congestion. Most TCM formulas for biyuan cannot do without Xinyi, but Xinyi is hairy and irritates the throat, so when taken internally it should be wrapped in a non-woven cloth bag during decoction.
TCM holds that biyuan with purulent discharge belongs to heat-toxin, so this formula focuses on clearing heat and detoxifying. Shanzhi is Zhizi (Gardenia jasminoides), which is best at clearing evil heat from the heart and lung in the upper jiao. Beimu has the action of opening and disseminating lung qi and draining down lung fire. Chaihu drains shaoyang fire and expels evils to the exterior. According to modern pharmacology, Chaihu, Zhizi and Beimu all have good therapeutic effects on the inflammatory lesions caused by upper respiratory tract infections, so they are suitably included here.
Danggui both invigorates blood and nourishes blood; moreover, according to the Shennong Bencao Jing (Divine Farmer's Classic of Materia Medica), Danggui is also a fairly good herb for stopping cough and dissipating nodules. In TCM terms, chronic illness necessarily leads to deficiency and chronic illness necessarily leads to stasis, so Danggui is used frequently in chronic disease. The postnasal drip of biyuan patients often causes coughing, and a small amount of Danggui also helps stop cough.
Thus Dr. Ling combined these six herbs to treat biyuan; the prescription is exquisitely constructed and remarkably effective. However, when this formula is used for nasopharyngeal carcinoma of the heat-toxin-binding type, its strength is still insufficient. It must be combined with Xiaoluo Tang (Melt-Nodules Decoction), plus additional herbs that soften hardness and dissipate nodules, and clear heat and detoxify—such as Tianhuafen (Trichosanthes root), Xiakucao (Prunella), Duanmuli (calcined oyster shell), Haizao (Sargassum), Kunbu (Ecklonia), Shancigu (Cremastra), Shandougen (Sophora tonkinensis), Banzhilian (Scutellaria barbata), Baihuasheshecao (Oldenlandia), Baimaogen (Imperata), Loufengfang (wasp nest)—to enhance the effect.