The Role of the Xiexin Decoction Series in Treating Digestive Tract Diseases (Part 1)

The Xiexin Tang (Heart-Draining Decoction) series among the classical TCM formulas can resolve some digestive tract diseases and a range of problems caused by them.

The Xiexin Tang series comprises several formulas: Xiexin Tang, Banxia Xiexin Tang, Dahuang Xiexin Tang, Fuzi Xiexin Tang, Shengjiang Xiexin Tang, and others are all formulas of the Xiexin Tang series.

In the past, Xiexin Tang treated various pi (fullness) syndromes. Because early Chinese medicine named diseases mainly after the symptoms patients themselves felt, there arose the disease called “epigastric pi” (xin xia pi), and Xiexin Tang was primarily used to treat “epigastric pi.”

The reason we say the greatest feature of TCM in the past was syndrome differentiation and treatment is also that the actions of Chinese herbs and formulas were all defined around the various syndromes presented by the patient. Xiexin Tang, as the name implies, is the formula that drains “epigastric pi.” What the ancients called “below the heart” (xin xia) mainly referred to the epigastric region. “Epigastric pi”, in today’s terms, means abdominal distension and gastric fullness and the like. Therefore this series of formulas mainly treats gastrointestinal diseases.

But gastrointestinal diseases can also cause many other problems—for example, mouth ulcers, gum bleeding, upper respiratory tract infections, and some inflammatory lesions of the urinary system and reproductive organs may also be secondary conditions caused by digestive tract diseases.

If the primary cause of such illnesses is a digestive tract disease, and that digestive tract disease is an indication of the Xiexin Tang series, then the Xiexin Tang series can be used to resolve them. I myself have used Xiexin Tang to treat a patient’s otitis media with good effect. But not all otitis media can be treated with Xiexin Tang, because some otitis media is not a secondary lesion induced by a digestive tract disease and does not present the Xiexin Tang indication; for such otitis media, Xiexin Tang will be ineffective.

Thus, applying the TCM idea of syndrome differentiation and treatment, we firmly grasp the patient’s principal contradiction. As long as the patient’s cause corresponds to the “syndrome” addressed by the Xiexin Tang series, the Xiexin Tang series can be used to treat them, achieving the effect of “treating different diseases with the same method.”

In the Shanghan Lun (Treatise on Cold Damage), the Xiexin Tang series mainly appears after the provisions on “chest bind” (jie xiong). Around the Xiexin Tang series, formulas such as Wuling San, Xuanfu Daizhe Shi Tang, and Chaihu Guizhi Ganjiang Tang are placed together to be distinguished from one another.

This shows that the causes of symptoms like “epigastric pi” and “chest bind” are also very complex. If the secondary “epigastric pi” and “chest bind” are caused by lower abdominal fullness and inhibited urination, one should use a diuretic formula like Wuling San. By the same token, if secondary abdominal distension is induced by hepatobiliary disease, one should use the Chaihu Guizhi Tang and Chaihu Guizhi Ganjiang Tang series. So although these symptoms look similar, the treatments must differ; this is what TCM calls “treating the same disease with different methods.”

In the Jingui Yaolue (Essential Prescriptions from the Golden Cabinet), Xiexin Tang appears in the chapter on “fright palpitations, vomiting of blood and nosebleed, lower bleeding, chest fullness, and blood stasis.” These conditions likewise have many causes and are not the indication of Xiexin Tang alone. That chapter therefore contains many other formulas set up for comparison with the Xiexin Tang syndrome.

Zhang Zhongjing was a physician of extremely rich clinical experience, so he distinguished the various syndromes with great care. He placed many similar diseases side by side for comparison: with the slightest change in symptoms, one decoction syndrome would shift into another. This is a particularly precious empirical spirit—a quality only a physician engaged in clinical practice rather than pure theoretical research would possess.

Later generations, based on Zhang Zhongjing’s discussions of the various formulas and syndromes, also divided the indications of the Xiexin Tang series into various types of epigastric pi. For example, Xiexin Tang belongs to “phlegm-qi pi,” Shengjiang Xiexin Tang to “food- and water-retention pi,” and Fuzi Xiexin Tang to “cold-heat pi.” This is mainly to help everyone understand the similarities and differences among the various Xiexin Tang formulas.

Only by distinguishing the indications of the various Xiexin Tang formulas through these fine details can we truly use Xiexin Tang well and solve the patient’s problems. Otherwise, simply abusing Xiexin Tang whenever a patient reports abdominal distension to the doctor will hardly solve the patient’s real problem.