Sanzhong Kuijian Tang from Li Dongyuan's Lanshi Micang (Ulcer Section)
'Sanzhong Kuijian Tang' is from the 'Ulcers and Sores' (Chuangyang Men) section of Li Dongyuan's medical work Lanshi Micang. The original text reads:
'Sanzhong Kuijian Tang: treats maxillary-axillary scrofulous sores, hard as stone, whether located below the ear to the supraclavicular fossa, on the shoulder, or below the ribs--all in the hand and foot Shaoyang meridians. Also treats scrofula spreading below the chin or to the cheekbone, hard and un-ulcerated, arising from the foot Yangming meridian. If either condition has ulcerated and discharges pus, it also treats it.
Huangqin (Scutellariae Radix) 24 g (washed in wine; half stir-fried, half raw), Caolongdan (Gentianae Radix, washed in wine and stir-fried four times), Gualougen (Trichosanthis Radix, filed and washed in wine), Huangbai (Phellodendri Cortex, wine-processed), wine-zhimu (Anemarrhenae Rhizoma), Jiegeng (Platycodi Radix), Kunbu (Eckloniae/Thallus) each 15 g, Chaihu (Bupleuri Radix) 12 g, Zhi Gancao (honey-fried Glycyrrhiza), Jing Sanleng (Sparganii Rhizoma, washed in wine), Ezhu (Curcumae Rhizoma, washed in wine and stir-fried), Lianqiao (Forsythiae Fructus) each 9 g, Gegen (Puerariae Radix), Baishao (Paeoniae Alba Radix), Dangguiwei (Angelicae Sinensis tail), Huanglian (Coptidis Rhizoma) each 6 g, Shengma (Cimicifgae Rhizoma) 1.8 g.
Cut the herbs coarsely. Take 18 g each time, with 2.8 cups of water; soak for most of a day first, then decoct to one cup and strain. Take hot after meals. Stretch the legs upward while lying down, let the head hang low, and take one mouthful at a time in ten small swallows. After taking, lie down as usual so the medicine stays above the diaphragm. Separately, take half a dose of the above, grind to a fine powder, refine with honey into pills the size of a mung bean; take over a hundred pills each time, washed down with a mouthful of the decoction reserved from above. Adding 15 g of Haizao (Sargassum), stir-fried, is also excellent.'
Li Dongyuan's formula treats lymph node enlargement, including cervical, supraclavicular and axillary nodes. It is a modification of Xiao Chaihu Tang. Li believed this disease belongs to the hand and foot Shaoyang meridians, hence he modified Xiao Chaihu Tang: remove Renshen, replace Banxia with Tianhuafen (i.e. Gualougen), and add heat-clearing herbs Huanglian, Longdancao, Huangbai and Zhimu, phlegm-dissolving herbs Jiegeng and Kunbu, and hardness-breaking and swelling-dispersing herbs Sanleng, Ezhu and Lianqiao; he also adds Gegen to release the muscles, Baishao to soften the liver, and Dangguiwei to invigorate blood and unblock the channels. Combined, these herbs harmonize Shaoyang, soften hardness, dissipate nodules, burst abscesses and disperse hard masses, so this is a formula that treats both root and branch.
Whether viewed from traditional Chinese medicine or modern pharmacology, this decoction by Li Dongyuan is an excellent formula for lymph node enlargement. The Huangqin, Gualougen, Longdancao, Huangbai, Sanleng, Ezhu and Lianqiao it uses are all modern anti-tumor herbs.
Li's method of administration is also worth emulating: half as a decocted powder held in the mouth, half as a pill. In other formulas in the 'Ulcers and Sores' section he even mentions that the dregs may be applied externally. This is a comprehensive approach: the decocted powder held in the mouth is easily absorbed; the pill slowly disintegrates for sustained effect; and external application of the dregs delivers the medicine through the skin. Combining systemic and local treatment is the goal. On one hand, this shows Li Dongyuan's superb skill and rich practical experience; on the other, it shows how difficult these diseases are--even a master like him could not rely on oral medicine alone.
Today this formula is often used for tuberculous lymphadenitis, infective lymphadenopathy, lymphoma and metastatic lymphatic tumors. It has some swelling-reducing and nodule-dispersing effect; combined with Xihuang Wan or Xiaojin Wan the effect is better. For cancer-related lymphadenopathy, combined with chemotherapy drugs the effect is better still.
This formula should not be converted into a decoction. These diseases usually require long courses and are hard to treat; powders and pills are gentle on the patient's stomach. The ancients therefore treated such conditions slowly with pills, powders, plasters and elixirs. Modern people, to avoid the trouble of making pills and powders, routinely convert everything to decoctions; this is not appropriate.