Qi Xian San: Clearing Heat, Resolving Toxin, Reducing Swelling, and Dispelling Nodules

“Qi Xian San” (Seven Sages Powder) originates from the Guan Zhu Fang Yao Bu (citing the Waike Zuan Yao). Its composition is: Zaojiaoci (Gleditsiae Spina), Zaojiaoci (Gleditsiae Fructus), Lianqiao (Forsythiae Fructus), Huanglian (Coptidis Rhizoma), Tianhuafen (Trichosanthis Radix), and Jinyinhua (Lonicerae Flos), each 1 liang (30g), and Tufuling (Smilacis Glabrae Rhizoma) 8 liang (240g). Grind all the above herbs together into a powder, and divide into seven equal portions. Each day take one portion, decoct with 600ml water down to 300ml, strain out the dregs, and take in two divided doses.

This formula clears heat and resolves toxin, reduces swelling and disperses nodules. It mainly treats scrofula (lymph node tuberculosis) at the early stage or already ulcerated. This formula treats heat-toxin-type swelling lesions, presenting with unexplained lumps around the body that are red in color, even suppurating and tender to the touch. The patient may also have accompanying symptoms such as constipation, scanty dark urine, and dry mouth and tongue.

In this formula, Zaojiaoci is the thorn growing on the honey locust tree, also called Zaojiao needle. TCM holds that it reduces swelling, promotes pus outflow, and searches out wind and kills worms. It is a commonly used herb in TCM for early-stage welling abscesses and sores, or for pus formed but not yet ulcerated; it treats scrofula (swollen lymph nodes), scabies and tinea, and leprosy. Zaojiaoci is one of the most commonly used herbs in TCM external medicine, but it has a hemolytic side effect, so it must be used carefully and not overdosed. The usual decoction dose is 3–10g; it is contraindicated in pregnancy.

Zaojiaoci (Gleditsia fruit) is the dried fruit of Gleditsia sinensis (family Fabaceae). It moistens the intestines and frees the stool, and reduces swelling and disperses nodules; it is commonly used for dry constipation, intestinal wind with bleeding, dysentery with tenesmus, phlegm-wheezing with fullness, hernial pain, scrofula, swellings and toxins, and sores and tinea. The usual dose of Gleditsia fruit is 1.5–5g; it is also mildly toxic and contraindicated in pregnancy.

Lianqiao is the dried fruit of Forsythia suspensa (family Oleaceae). Its main actions are to clear heat and resolve toxin, disperse wind-heat, disperse abscesses and nodules, and promote diuresis. It is commonly used for exterior contraction of warmth-heat diseases, wind-heat colds, welling abscesses and sores, breast abscess, lung abscess, scrofula and phlegm nodules, and heat strangury with painful urination. Forsythia is also an important herb in external medicine. Its usual dose in decoction is 3–10g.

Jinyinhua is another heat-clearing, toxin-resolving, wind-heat-dispersing, swelling-reducing, nodule-dispersing herb often paired with Forsythia; Yin Qiao San is composed mainly of Lonicera and Forsythia. Honeysuckle treats exterior contraction of warmth-heat diseases, wind-heat colds, welling abscesses and sores, intestinal abscess, lung abscess, breast abscess, and heat-toxin dysentery. Both Lonicera and Forsythia have anti-tumor effects. The usual dose of Honeysuckle is 10–30g; at high dosage it can be used up to 100–200g.

Huanglian is the dried rhizome of Coptis chinensis (family Ranunculaceae). It is bitter in taste and cold in nature, clearing heat and drying dampness, and draining fire and resolving toxin. It mainly treats damp-heat obstructing the stomach with fullness and vomiting, diarrhea and dysentery, jaundice, high fever and irritability and clouded spirit in warmth diseases, internal-heat vexation and insomnia, stomach-fire toothache, mouth and tongue ulcers, and welling abscesses and sores. Coptis also has anti-tumor and immunomodulatory effects. Its usual decoction dose is 3–6g; it is very bitter, and many patients cannot tolerate it.

Tianhuafen is the dried root of Trichosanthes kirilowii (family Cucurbitaceae). It is bitter and slightly sweet-cold in nature, clearing heat and generating fluids, clearing the lung and moistening dryness, reducing swelling and expelling pus. It is one of the commonly used TCM herbs for welling-abscess-type diseases; an injectable preparation made from it can also induce labor. Tianhuafen lowers blood sugar, and has antiviral and anti-cancer effects. Its usual decoction dose is 10–15g, or it may be put into pills or powder.

Tufuling is the dried rhizome of Smilax glabra (family Liliaceae), also known as Lengfantuan or Cizhu Ling. Its main actions are to resolve toxin, dispel dampness, and unblock the joints; it is commonly used for limb spasms caused by syphilis or mercury poisoning, rheumatic bi pain, strangury and turbid discharge, leukorrhea, beriberi, eczema, and damp sores. Modern pharmacological research shows Tufuling alleviates mercury poisoning, counteracts gossypol toxicity, and has anti-tumor, antibacterial, anti-atherosclerotic, ischemic-myocardium-protective, diuretic, analgesic, liver-protective, anti-arrhythmic, and cellular-immunity-inhibiting effects. Its usual decoction dose is 15–60g; besides being drunk, the decoction may also be applied externally. When using Tufuling, patients must not drink tea, otherwise hair loss may easily occur.

Tufuling is the most heavily dosed herb in this formula: all the other herbs use 1 liang, but Tufuling uses 8 liang. This is mainly to draw on Tufuling's actions of resolving toxin, dispelling dampness, and reducing swelling; Tufuling is also one of the author's commonly used anti-tumor herbs. When used in decoction to treat tumors, the minimum dose should be 30g.

Virtually every herb in this formula has the action of reducing swelling and dispersing nodules, and all also clear heat, resolve toxin, and drain dampness. Therefore, this formula should be used cautiously in patients who have no signs of heat-toxin, with clear, long urination and loose stools.