Two Verified Cases Treated with Maxing Erchen Decoction
Maxing Erchen Decoction comes from Chinese Pediatrics. It is developed by adding mahuang (Ephedra) and xingren (Apricot kernel) to Erchen Decoction (Two-Aged Decoction). The commonly used dosage is: banxia (Pinellia) 15g, juhong (Tangerine red) 15g, fuling (Poria) 9g, zhigancao (Honey-fried Licorice) 5g, mahuang (Ephedra) 3g, xingren (Apricot kernel) 6g, shengjiang (Fresh ginger) 7 slices, wumei (Smoked Mume fruit) 1 piece.
This formula is a combination of Erchen Decoction and San'ao Decoction. Erchen Decoction is the representative TCM formula for drying dampness and resolving phlegm, and regulating qi and harmonizing the middle jiao; San'ao Decoction is Mahuang Decoction (Ephedra Decoction) with guizhi (Cinnamon twig) removed. Mahuang Decoction is the representative TCM formula for sweating to release the exterior and dispersing lung qi to stop wheezing; removing guizhi reduces its exterior-sweating strength, so San'ao Decoction focuses more on dispersing lung qi and stopping wheezing. The combined effect of these two formulas focuses on drying dampness and resolving phlegm, regulating qi and harmonizing the middle jiao, and dispersing lung qi to stop wheezing. It can treat cough and wheezing due to abundant phlegm and excessive dampness, presenting as cough with abundant white, clear, thin sputum, chest oppression and poor appetite, lassitude and fatigue, a pale tongue with white slippery coating, and a slippery pulse.
Clinically, many diseases cause the above symptoms: patients have abundant phlegm, chest tightness, chest pain, wheezing, shortness of breath, or incessant coughing. In Western medicine, phlegm-resolving drugs are generally used, but for some chronic disease patients the effect of phlegm-resolving drugs is poor, leading to persistent, intractable difficult diseases. In TCM, based on the principle of treatment based on pattern differentiation, one can judge the patient's pattern type from clinical symptoms and use formulas like Maxing Erchen Decoction to relieve them.
Here are two recent cases I treated with Maxing Erchen Decoction as examples.
Case One:
Hu, a nasopharyngeal carcinoma patient, has been treated with TCM since developing nasopharyngeal carcinoma, for over six years now. His living condition is fair, and the tumor has shrunk multiple times, rebounded multiple times after shrinking, and shrunk again after treatment following each rebound. The only persistent issue is purulent nasal discharge year-round, causing nasal congestion and poor breathing, and his ears also frequently discharge pus. He is often woken at night by this problem. It is very difficult to blow his nose completely clear; soon after blowing, mucus returns, greatly affecting his quality of life.
In 2021, the patient had these symptoms, and I treated him at the time with Chinese patent medicines such as Lianhua Qingwen Capsules and Maxing Shigan Decoction; the symptoms resolved and he returned to normal for a while. In 2022, the symptoms recurred. He took last year's medicine on his own but it was ineffective. He was very distressed, so he asked me to think of another approach.
Based on his condition, I tried several formulas without effect. On August 2, 2022, I decided to try Maxing Erchen Decoction and recommended the following prescription: fabanxia (Prepared Pinellia) 10g, juhong (Tangerine red) 10g, fuling (Poria) 6g, zhigancao (Honey-fried Licorice) 3g, zhimahuang (Honey-fried Ephedra) 3g, xingren (Apricot kernel) 6g, wumei (Smoked Mume fruit) 1 piece, shengjiang (Fresh ginger) 7 slices. One dose daily, decocted in water and taken in two divided doses.
After taking two doses, the patient felt improvement, especially in the left nostril which had begun to open. I had him continue the same formula (effective formulas should not be changed) for another 5 doses. After completing the 5 doses, he reported feeling much better than before, but still had to blow his nose every few minutes, was woken once around 3 AM by congestion, and tended to dry cough.
On August 9, 2022, based on the symptoms he reported, I adjusted the prescription as follows: fabanxia 10g, juhong 10g, fuling 6g, zhigancao 3g, zhimahuang 3g, xingren 6g, lugen (Rhizoma Phragmitis) 30g, shengyaoshi (Gypsum) 15g, wumei 1 piece, shengjiang 7 slices. Three doses.
After taking three doses, the patient reported that nasal discharge was much reduced, the left nasal cavity was basically completely open, the right nasal cavity still occasionally felt congested, and he had dry cough and pus discharge from the middle ear. I adjusted the prescription again as follows: fabanxia 10g, juhong 10g, fuling 6g, zhigancao 3g, zhimahuang 3g, xingren 6g, lugen 30g, shengyaoshi 15g, beishashen (Glehnia root) 10g, maidong (Ophiopogon tuber) 15g, wuweizi (Schisandra fruit) 10g, wumei 1 piece, shengjiang 7 slices. Three doses, aiming to further relieve the patient's symptoms.
Nasopharyngeal carcinoma patients often present with nasal congestion, tinnitus, and hearing loss, with large amounts of discharge in the nasal cavity and ear canals, chest tightness and shortness of breath, and poor breathing. Using Maxing Erchen Decoction to relieve symptoms and improve quality of life is also meaningful for such patients.
Case Two:
This case is my teacher's wife, who has had asthma for many years. Every time she catches a cold, it basically triggers intractable cough and wheezing. This summer she caught a cold, and I treated her with Mahuang Decoction; after treatment she no longer had fever, but the cough and wheezing were still severe, coughing to the point of sternal pain, and even hearing a cracking sound in the sternum when coughing. Mahuang Decoction could not relieve the cough and wheezing; after switching to Cha Ge Jieji Decoction, symptoms improved noticeably for one day, then recurred, and Cha Ge Jieji Decoction was again ineffective.
On July 31, my teacher's wife reported severe cough, phlegm rales in the throat, chest pain, and inability to sleep. I decided to switch to Maxing Erchen Decoction, prescribing: fabanxia 10g, juhong 10g, fuling 6g, zhigancao 3g, zhimahuang 3g, xingren 6g, wumei 1 piece, shengjiang 7 slices.
On August 1, she reported improvement after taking the medicine. On August 3, the cough continued to decrease, but phlegm rales still occasionally appeared in the throat, and chest pain lessened. I added yuxingcao (Houttuynia) 3g to the above formula.
On August 5, she reported that improvement over the previous two days was less pronounced than before, she still had chest pain, did not dare to cough forcefully, and had phlegm rales in the throat that seemed like signs of an impending asthma attack. I therefore removed yuxingcao and added more cough-suppressing and wheezing-calming herbs, blood-activating and stasis-resolving herbs, and root-securing and foundation-stabilizing herbs to the previous formula.
The modified prescription was: fabanxia 10g, juhong 10g, fuling 6g, zhigancao 3g, zhimahuang 3g, xingren 6g, wumei 1 piece, ziwan (Aster) 10g, kuandonghua (Tussilago) 10g, zhuru (Bamboo shavings) 6g, danshen (Salvia miltiorrhiza) 15g, danggui (Angelica sinensis) 12g, huangjing (Polygonatum) 15g, yiyiren (Coix seed) 30g, shengjiang 7 slices.
After taking this formula, symptoms lessened day by day. By August 11, 2022, my teacher's wife reported much improvement, so I had her continue the same formula (effective formulas unchanged) for a while longer to consolidate the effect. Asthma patients most fear colds; once a cold occurs, it is like facing a major enemy, and asthma easily recurs at this time. Effective treatment must be taken as soon as possible to control recurrence.
Combining two or more formulas to treat disease is a common TCM approach for patients with complex conditions. Maxing Erchen Decoction is a typical representative of combining two formulas. Chronic disease patients have complex conditions that are prolonged and difficult to heal; combining formulas for gentle treatment, and once effective, adhering to the unchanged formula and proceeding slowly, often yields good results.