Qingwei Lipi Tang: A TCM Formula for Oral Ulcers and Gastric Ulcers
Qingwei Lipi Tang is a prescription from the Yizong Jinjian (Golden Mirror of Medicine), composed of cangzhu (atractylodes), chenpi (tangerine peel), houpo (magnolia bark), gancao (licorice), huanglian (coptis), huangqin (scutellaria), and dahuang (rhubarb)—seven herbs. In effect it is a combination of Dahuang Huanglian Xiexin Tang and Pingwei San.
A common adult dose is: cangzhu 12 g, chenpi 12 g, houpo 12 g, gancao 9 g, huanglian 6 g, huangqin 6 g, dahuang 3–6 g. Pediatric doses vary by age: generally one-fifth for newborns, one-quarter for ages 1–3, one-third for ages 4–6, one-half for ages 7–10, and the adult dose for ages over 10.
The best way to prepare this formula is to first decoct cangzhu, chenpi, houpo, and gancao, pour off the liquid while hot, then steep huanglian, huangqin, and dahuang in the hot liquid for five minutes, and strain before drinking. This is because the three herbs of Dahuang Huanglian Xiexin Tang do not tolerate prolonged decoction; too long a boil or too high a temperature destroys their active constituents.
Pingwei San, made of cangzhu, chenpi, houpo, and gancao, is a TCM dampness-drying formula. It dries dampness and activates the spleen, moves qi and harmonizes the stomach. It treats the pattern of dampness stagnating in the spleen and stomach: epigastric fullness and distention, no desire to eat, bland taste in the mouth, nausea and vomiting, belching and acid regurgitation, heavy limbs, lassitude and drowsiness, frequent loose stools, a thick greasy white tongue coating, and a moderate pulse. Today it is used mainly for chronic gastritis, digestive dysfunction, and gastric and duodenal ulcers presenting as dampness stagnating in the spleen and stomach.
Dahuang Huanglian Xiexin Tang, for its part, is the representative classical formula for "glomus below the heart" (the epigastrium)—epigastric glomus and fullness with damp-heat lingering in the spleen and stomach, leading to reduced eating, which are also common symptoms of chronic gastritis, digestive dysfunction, and gastric and duodenal ulcers.
Thus Qingwei Lipi Tang, the combination of these two formulas, works even better for the range of symptoms caused by digestive disease. The Yizong Jinjian states that Qingwei Lipi Tang treats "rich wine and fatty foods causing damp-heat disease: glomus and distention, belching and vomiting, inability to eat, acid regurgitation, nausea, and belching, together with sticky foul stool, scanty dark urine, craving cold food, and oral and tongue ulcers."
This set of symptoms is what modern medicine calls acid reflux and heartburn from excess stomach acid, indigestion, irregular bowel movements, gastric ulcers, and oral ulcers. Generally, Western medicine treats such patients mainly with proton-pump inhibitors, sometimes adding antibiotics.
Such patients are often Helicobacter pylori-positive. During treatment one may test for H. pylori; if positive, one may consider quadruple therapy to eradicate it. But H. pylori resistance is growing and the eradication rate falling, and eradication does not always immediately relieve symptoms. So if eradication fails, there is still a place for this formula.
If the patient's urine is yellow and scanty, this formula may be combined with Daochi San, made of mutong (clematis/aristolochia stem), raw rehmannia (sheng dihuang), raw licorice tip (sheng gancao shao), and bamboo leaves (zhuye), with the dose adjusted as appropriate.