Shengma Gegen Decoction: Releasing the Exterior, Promoting Rash Eruption, Stopping Diarrhea and Antiviral
Shengma Gegen Decoction comes from the Taiping Huimin Heji Jufang (Prescription Pharmacy Harmonous Formula). It consists of Shengma (Rhizoma Cimicifugae), Baishao (Radix Paeoniae Alba), Zhigancao (honey-fried Radix Glycyrrhizae) and Gegen (Radix Puerariae) in a 2:2:2:3 ratio. The herbs are mixed and ground into coarse powder; each dose uses 3 qian (9 g), decocted in water. In modern practice it is mostly given as a decoction or pill; adults may use: Shengma 6 g, Baishao 6 g, Zhigancao 6 g, Gegen 9 g, decocted in one and a half bowls of water to eight-tenths of a bowl.
This formula has the actions of cooling and resolving the muscle layer, promoting rash eruption and resolving toxin. It is indicated for contraction of seasonal epidemic pathogens with headache, fever and aching limbs; or early-stage measles that has not fully surfaced. In modern practice it is used for influenza, acute tonsillitis, infantile diarrhea, measles and hepatitis B. When used for the common cold, the medication indication is cough, body fever and headache, red eyes and tearing, bitter mouth and dry throat, red tongue with thin coating, and floating pulse; such symptoms belong to wind-heat cold.
Shengma in this formula resolves the muscle layer, promotes rash eruption and resolves toxin; Gegen also resolves the muscle layer and promotes rash eruption, generates fluids and stops thirst, and Gegen also stops diarrhea. This formula is named after Shengma and Gegen precisely because these two herbs are the chiefs, so its main indications are aching limbs, dry mouth and throat, headache and fever—diseases mostly seen in acute infections such as influenza, tonsillitis, enteritis with diarrhea, and measles.
Baishao combined with Gancao in this formula is Shaoyao Gancao Decoction from the Shanghan Lun. Shaoyao Gancao Decoction, sour-sweet engendering yin, relaxes urgency and stops pain; it is a classic TCM formula for tendon-moisture loss from febrile disease, leg and foot spasms, abdominal urgency pain, and liver-spleen disharmony. It is also called the "Crutch-Casting Decoction," describing how it lets those who cannot walk due to leg pain cast aside their crutches. Combining Shaoyao Gancao Decoction with Shengma and Gegen treats both branch and root.
Shengma Gegen Decoction can be used for infantile autumn-summer diarrhea. Such diarrhea usually has both an exterior pattern (fever) and an interior pattern (diarrhea with abdominal pain); Shengma and Gegen release the exterior to expel pathogens, Baishao and Gancao relax urgency and stop pain, and Gegen stops diarrhea, so it treats both exterior and interior and addresses both branch and root. For high fever that is hard to reduce, Lingyangjiao powder (Antelope horn) may be added; for wind-heat convulsions, Gouteng may be added; for heavy damp-heat, Huanglian, Huangbai, Zhizi and Baitouweng may be added; for severe diarrhea, Shiliupi (pomegranate peel) may be added; with indigestion, Jiao San Xian may be added.
Modern TCM has found this formula to be an excellent formula for hepatitis B. Adding Sheng Huangqi (raw Astragalus) and Jinyinhua (Honeysuckle) each 30 g, plus Chenpi 6 g, and replacing Baishao with Chishao, forms a base formula for hepatitis B. With jaundice, add Yinchen and Jinqiancao each 30 g; with dull liver-area pain, add Chuanlianzi and Yanhusuo each 30 g; with abdominal distension and poor appetite, remove Huangqi and add Muxiang 10 g, Chao Maiya (stir-fried barley sprout) 20 g, Sharen 6 g; with ascites, add Baizhu, Fulin, Zhuling, Zexie each 10 g, Cheqianzi 15 g. The Anhui Journal of Clinical TCM 1997(5) reported treating 300 hepatitis B cases by this approach, with 195 cured and a cure rate of 65%.
Shengma Gegen Decoction can also be used for chronic urticaria, eczema and other skin diseases of the unrelieved-exterior, not-yet-erupted-rash pattern, as well as autumn-summer allergic skin diseases mostly caused by pathogens of unknown origin.
From the ancients' recorded indications of Shengma Gegen Decoction, we can roughly infer that, from a modern medical viewpoint, it has a strong anti-pathogen (viral or bacterial) action. It is especially effective against pathogens causing fever, dry and bitter mouth, diarrhea (or loose stools), aching limbs, headache and rash.