Skillful Use of Baohe Pills for Gastritis, Indigestion, Cough, Diabetes, and Other Common Conditions
Baohe Pills (Baohe Wan) are a very common patent Chinese medicine and are the foremost formula among the digesting and guiding agents in TCM formula studies. They are extremely widely used and can treat various pediatric conditions, gastrointestinal diseases such as gastritis and esophagitis, respiratory diseases such as cough and asthma, mild gastroparesis caused by diabetes, and the poor appetite and chest-abdominal pain seen in tumor patients after surgery or chemoradiotherapy; when applied appropriately, the effect is excellent.
According to the Baohe Wan package insert, it has the actions of digesting food, guiding out stagnation, and harmonizing the stomach. It is indicated for food stagnation and stoppage, epigastric and abdominal distention, belching with putrid odor, acid regurgitation, and lack of appetite. But in practice Baohe Wan also has good efficacy on pediatric cough, pediatric common cold, asthma, mild gastroparesis caused by diabetes, and the poor appetite caused by chemoradiotherapy in tumor patients.
Baohe Wan comes from Danxi Xinfa (Danxi's Experiential Therapeutic Methods) by the famous Yuan-dynasty TCM master Zhu Danxi. It consists of hawthorn (Shanzha), medicated leaven (Shenqu), radish seed (Laifuzi), tangerine peel (Chenpi), Poria (Fuling), and forsythia (Lianqiao). It provides good relief for symptoms caused by various diseases, such as indigestion, belching, acid regurgitation, poor appetite, chest and back pain, cough and wheezing.
Children easily develop food stagnation from overeating; undigested food stagnation can in turn cause abdominal distention, diarrhea, cough, restless sleep at night, night crying, mouth ulcers, talking in sleep, and somnolence. According to the TCM principle of "treating different diseases with the same method," as long as the pattern is undigested food stagnation, whatever the presenting symptoms, Baohe Wan can be used. Nowadays many infants are fed formula; the rashes, night terrors, and indigestion often caused by formula feeding also respond immediately to Baohe Wan.
Below are several pediatric case records by Yin Liyuan in which Baohe Wan was used to treat common pediatric conditions.
1. Pediatric cough due to food stagnation
Yan XX, female, age 3, first seen March 7, 2006. The child had coughed for over fifty days and had been treated at multiple places without improvement. Findings: cough with phlegm rattle in the throat, mild by day and severe by night, paroxysmally worse in the pre-dawn hours, low-grade fever that is not obvious to touch, abdominal distention and poor appetite, occasional vomiting of food after eating, restless at night and preferring to sleep on her stomach, warm palms, loose stools, red lips and tongue with a thick greasy coat, and a deep, sluggish finger-vein sign. The pattern was food stagnation in the middle jiao with stomach qi rebelling to the lung. Modified Baohe Wan was prescribed: radish seed (Laifuzi) 8g, forsythia (Lianqiao) 10g, Poria (Fuling) 10g, processed Pinellia (Fa Banxia) 8g, tangerine peel (Chenpi) 6g, hawthorn (Shanzha) 12g, medicated leaven (Jianqu) 12g, rice sprout (Guyá) 12g, Scutellaria (Huangqin) 8g, Trichosanthes (Gualou) 8g. After two doses the cough and phlegm rattle immediately subsided; two more doses of the same formula were given. After four doses total, all symptoms resolved and appetite gradually increased. Note: Cough, though attributed to the lung, has many causes. Cough due to food stagnation is often overlooked and treated in vain. This child's cough was long-standing; examination showed it was caused by food stagnation in the middle jiao, failure of transportation and transformation, turbid phlegm rebelling to the lung, and accumulated heat steaming upward. Hence Baohe Wan plus Scutellaria and Trichosanthes to clear heat and transform phlegm was effective.
2. Pediatric anorexia
Zhao X, male, age 4, first seen September 2, 2007. For over two months the child's food intake had gradually decreased; he craved raw and cold fruits, sweets, and fragrant dry foods. In the past half month he had even become anorexic, eating only a little each day, liking to drink, restless at night, with dry hard stools. He had taken several doses of both Chinese and Western medicines and had self-medicated with lactasin, yeast tablets, and spleen-strengthening syrup, all without effect.
On presentation the child's spirits were fair; he played as usual but was impatient and irritable, with abdominal distention and occasional pain, a yellow-white thick greasy tongue coat, and a slippery slightly rapid pulse. The pattern was spleen-stomach disharmony with food stagnation in the middle jiao. Treatment was modified Baohe Wan: radish seed (Laifuzi) 10g, forsythia (Lianqiao) 10g, Poria (Fuling) 12g, processed Pinellia (Fa Banxia) 6g, tangerine peel (Chenpi) 8g, charred hawthorn (Jiao Shanzha) 12g, medicated leaven (Shenqu) 12g, rice sprout and wheat sprout (Gu and Mai) 15g each, coptis-like picrorhiza (Hu Huanglian) 6g, Curcuma zedoaria (Ezhu) 5g, Cyperi rhizome (Xiangfu) 19g. Three doses were prescribed, with avoidance of raw and cold foods. Second visit: symptoms improved; he was now eating about 150g daily. The previous formula minus zedoaria, with Agastache (Huoxiang) and Dioscorea (Shanyao) added, was continued for three doses; after finishing, appetite greatly increased, the abdomen was soft, bowel movements were smooth, and sleep was peaceful. He was advised to take spleen-strengthening powder for aftercare. Note: Children eat without knowing satiety, favor raw and cold fruits and rich sweet foods, but their zang-fu organs are tender and the spleen is often deficient, easily leading to failure of spleen transportation, stomach disinterest in food, and spleen-stomach disharmony. Anorexia is divided into excess and deficiency; this child was the excess type. Accumulated food must be digested and guided out; Baohe Wan plus Hu Huanglian to clear heat, zedoaria and Cyperi to move qi and guide stagnation, Agastache to aromatically awaken the spleen, and Dioscorea to fortify the spleen—six doses brought recovery.
3. Pediatric somnolence
Zhang XX, female, age 1, seen May 21, 2008.
The mother reported: the child had been drowsy and disinterested in food for three days; all laboratory tests were normal. After one dose each of Chinese and Western medicine without improvement, they sought consultation. The child was bottle-fed; one week before falling ill, irregular feeding had caused poor appetite and irritability, followed by the present condition.
On examination: the child was drowsy as if asleep, could not be roused even when played with, fatigued, skin not hot, abdomen distended, palms warm, no bowel movement for three days, scant urine, red tongue with thick greasy coat, and a deep sluggish finger-vein sign. This was caused by irregular nursing, stagnation in the middle jiao. Treatment was to disperse accumulation and guide stagnation, using modified Baohe Wan: radish seed (Laifuzi) 10g, Poria (Fuling) 10g, processed Pinellia (Fa Banxia) 6g, tangerine peel (Chenpi) 6g, hawthorn (Shanzha) 12g, medicated leaven (Jianqu) 12g, Cyperi (Xiangfu) 8g, Curcuma zedoariae (Sanleng) 6g, zedoaria (Ezhu) 5g, wine rhubarb (Jiu Dahuang) 4g. One dose was decocted and taken; that night the child passed a foul stool. The next morning she was smiling as usual and took a little milk and food. At the afternoon follow-up, the formula minus the harsh Sanleng, Ezhu, and wine rhubarb was given for one more dose, and recovery was reported. Note: Somnolence resembles "pathological preference for lying down"; it is a condition of sleepiness, most often due to dampness excess, spleen deficiency, or gallbladder heat. This child's condition arose from irregular feeding damaging the spleen and stomach, stagnant in the middle jiao and obstructing qi movement. Hence Baohe Wan, which digests food and guides stagnation and clears heat and drains dampness, plus Sanleng, Ezhu, and Xiangfu to move qi and disperse stagnation, and wine rhubarb to unblock the bowels, was effective.
4. Pediatric night crying
Zhou XX, female, 1 year 8 months, first seen May 11, 2007. The mother reported: for half a month the child had cried irritably every night from midnight until cockcrow, requiring care by rotation, only resting toward dawn; she ate little, stools alternated between dry and loose and contained undigested food. After a week of Chinese and Western medicines without improvement, plus a week of hospitalization elsewhere with no change, they returned for consultation. The child was mainly bottle-fed, with ordinarily poor appetite and restless sleep.
On examination: emaciated, listless, blue-yellow complexion, red tongue with thick greasy coat, clear voice, sour-smelling stools, a醒后 bad taste in the mouth, abdominal fullness with a burning sensation, warm palms, and a purple sluggish finger-vein sign. This was due to irregular feeding, food stagnation in the middle jiao, and obstructed qi movement. Modified Baohe Wan was prescribed: forsythia (Lianqiao) 10g, radish seed (Laifuzi) 8g, Poria (Fuling) 10g, processed Pinellia (Fa Banxia) 6g, tangerine peel (Chenpi) 6g, hawthorn (Shanzha) 10g, medicated leaven (Jianqu) 10g, Cyperi (Xiangfu) 10g, cicada slough (Chantui) 6g, picrorhiza (Hu Huanglian) 8g, zedoaria (Ezhu) 4g. After two doses all symptoms diminished, but she still cried irritably for about an hour each night; two more doses of the original formula were given. After four doses, sleep was peaceful, appetite gradually increased, and urination and defecation were regular. Note: Pediatric night crying is most often due to cold zang, heart heat, fright, or heart yin insufficiency. But children's zang-fu are tender and the spleen often deficient; irregular feeding and excessive raw and cold food damage the spleen and stomach, causing malfunction, food stagnation in the middle jiao, and blocked qi movement; when the Yangming's duty of closing at night fails, this disease may arise. This child's night crying was due to food stagnation, so Baohe Wan plus Xiangfu and Ezhu to move qi and guide stagnation, Chantui to dispel wind and calm spasms, and Hu Huanglian to clear heat was used; four doses brought cure.
5. Pediatric talking in sleep. Huang XX, female, age 5.
First seen August 12, 2009. Since age 3 the child had often mumbled in deep sleep; medication at multiple places only worsened it. She would even suddenly sit up in sleep, wave her limbs, talk in her sleep, and laugh; if questioned she could answer, and on waking it stopped, but as soon as she closed her eyes she talked again. On examination: spirit poor, yellow complexion, lusterless hair, abdominal distention, poor appetite, dry hard stools, red tongue with yellow greasy coat, deep wiry forceful pulse. The pattern was food stagnation in the middle jiao, which over time transformed into heat that harassed the spirit. Modified Baohe Wan: forsythia (Lianqiao) 10g, radish seed (Laifuzi) 12g, Poria (Fuling) 10g, processed Pinellia (Fa Banxia) 6g, tangerine peel (Chenpi) 8g, hawthorn and medicated leaven (Zha and Qu) 15g each, rice sprout (Guyá) 15g, Cyperi (Xiangfu) 10g, picrorhiza (Hu Huanglian) 8g, Curcuma aromatica (Yujin) 8g, Polygala (Yuanzhi) 5g, Acorus (Shichangpu) 6g, Dragon bone (Longchi) 15g. After five doses, on follow-up ten days later all symptoms were cured except occasional restlessness in sleep. Note: "Sleep talking" is murmuring during sleep with unclear articulation, stopping on waking and resuming on closing the eyes. It is mostly due to heart yin deficiency with heart flame flaming internally, gallbladder heat, or stomach disharmony. In this child, food stagnation in the middle jiao damaged the spleen and stomach, water-dampness accumulated internally, stagnation transformed to heat, and phlegm-heat obstructed and harassed the spirit above. When the stomach is not harmonized, sleep is not peaceful; hence Baohe Wan plus Xiangfu to move qi and guide stagnation, Hu Huanglian to clear heat, Yujin, Yuanzhi, and Shichangpu to scour phlegm and open the orifices, and Dragon bone to settle fright, calm the spirit, and remove vexed heat.
6. Pediatric fever
Wang XX, male, age 4, seen August 13, 2009. The child had had a low fever for over a week, temperature fluctuating between 37.5°C and 38.5°C, mild by day and severe by night, burning palms, heat above and cold below, no appetite, restless sleep, constipation; after Chinese and Western medicines failed, he came for consultation.
On examination: spirit poor, blue-yellow complexion, abdominal fullness with a burning sensation, lower limbs lacking warmth, red lips and tongue, thick greasy coat, rapid pulse. The pattern was dietary internal injury, stagnation in the middle jiao, spleen failing to transform dampness, stagnant steaming producing heat. Treatment was to digest food and guide stagnation, using modified Baohe Wan: forsythia (Lianqiao) 12g, radish seed (Laifuzi) 10g, Poria (Fuling) 10g, processed Pinellia (Fa Banxia) 6g, tangerine peel (Chenpi) 8g, medicated leaven (Shenqu) 12g, Cyperi (Xiangfu) 10g, Sweet wormwood (Qinghao) 12g, picrorhiza (Hu Huanglian) 7g, black Morning Glory (Hei Chou) 8g. After two doses the fever cleared, bowels moved, sleep was peaceful, and appetite gradually increased; cure was reported. Note: Pediatric fever is a symptom of many pediatric diseases; treatment must investigate the cause and follow the pattern for good results. This child's fever had persisted over a week due to food stagnation in the middle jiao, water-dampness failing to transform, and stagnant steaming producing heat. Baohe Wan was used to digest food and guide stagnation, plus Qinghao and Hu Huanglian to clear heat and dispel the pathogen, Hei Chou to unblock the bowels, and Xiangfu to disperse accumulated qi. Conclusion: Baohe Wan is a light formula for digesting food and guiding stagnation, designed for food and phlegm stagnation internal to the spleen and stomach with righteous qi not yet deficient. In the formula, hawthorn and medicated leaven excel at digesting accumulation from wine, meat, and wheat foods; radish seed disperses accumulation and simultaneously descends qi and loosens distention; the three together resolve all kinds of food stagnation. Tangerine peel moves qi and aromatically awakens the spleen; Pinellia dries dampness and transforms phlegm; Poria leaches out dampness; forsythia clears heat and disperses accumulation. Combined, these herbs digest the accumulated food and harmonize the stomach qi. Children's zang-fu are tender, body and qi not yet full, liver often exuberant, spleen often deficient; their transportation function is not yet mature, yet they need the refined essence of water and grain for growth more urgently than adults. If diet is irregular or feeding improper, the spleen and stomach are easily damaged, leading to various conditions caused by food stagnation. Using Baohe Wan with pattern-based additions to treat these conditions has achieved good results, embodying the TCM principle of "treating different diseases with the same method."
Pediatric food stagnation also commonly causes conditions such as pediatric eczema. Professor Ren Qin often uses Baohe Wan to treat pediatric eczema; below are Professor Ren's eczema case records.
Case 1: Patient, female, age 6, March 5, 2013. Widespread red papules all over the body for one week.
First visit: One week prior, the child developed scattered red papules all over the body, most obvious on the chest and back, densely packed, with marked local oozing, bleeding when scratched, unbearable itching, restless sleep, normal appetite and bowel movements. Spirit fair; skin bore scratch marks; papule bases were red. Tongue pale red with thin yellow coat, pulse floating rapid. Self-applied Erfukang without much effect. This was wind-damp-heat accumulating and binding in the skin. Treatment: dispel wind and clear heat, fortify the spleen and harmonize dampness, cool blood and resolve toxicity. Formula: Baohe Wan combined with Xiaofeng Powder, modified. Prescription: tangerine peel (Chenpi) 10g, Pinellia (Banxia) 10g, Schizonepeta spike (Jingjisui) 10g, Saposhnikovia (Fangfeng) 6g, cicada slough (Chantui) 6g, Arnebia (Zicao) 10g, Angelica (Danggui) 10g, Dictamnus root bark (Baixianpi) 10g, Kochia (Difuzi) 10g, forsythia (Lianqiao) 10g, Atractylodes (Cangzhu) 10g, Phellodendron (Huangbai) 6g, charred hawthorn (Jiao Shanzha) 10g, charred wheat sprout (Jiao Maiya) 10g, charred medicated leaven (Jiao Shenqu) 10g, white peony (Baishao) 10g, raw Rehmannia (Shengdi) 10g, Moutan bark (Danpi) 6g, red peony (Chishao) 10g, raw Dragon bone (Sheng Longgu) 10g, licorice (Gancao) 3g. Second visit (March 12): after the medicine, body papules gradually decreased, some oozing had crusted, itching lessened, occasional scratch marks, able to sleep peacefully at night, appetite and bowels normal, red tongue with thin white coat. The same formula was continued for 14 doses; later the condition was reported stable without recurrence. Note: This pattern is mostly due to internal accumulation of damp-heat, external contraction of wind, and wind-damp-heat binding in the skin. Symptoms include marked itching, bright red rashes, generalized or localized distribution, with papules, vesicles, erosion, and oozing. Treatment should dispel wind and drain dampness, clear heat and stop itching; Baohe Wan combined with Xiaofeng Powder, modified. The Xiaofeng Powder from Waike Zhengzong originally treated "wind-dampness invading the blood vessels, causing sores and scabies with incessant itching, as well as wind-heat hidden rashes in adults and children, cloud-like patches all over, appearing and disappearing." Wind is the chief of the hundred diseases; dispersing wind removes the itching. Hence tangerine peel and Pinellia fortify the spleen and harmonize the stomach, expel dampness and stop itching; Schizonepeta, Saposhnikovia, cicada slough, and Arnebia acridly scatter and penetrate, dispelling wind pathogen so that itching stops; Dictamnus, Kochia, Atractylodes, and Phellodendron clear heat and drain dampness, drying dampness to stop itching—used for the dampness pathogen; forsythia clears heat and drains fire—used for the heat pathogen; the charred three digestants (Jiao Sanxian) digest food and fortify the spleen; wind-heat stagnating internally easily consumes yin-blood, and the warm-drying wind-expelling dampness-draining herbs may damage yin-blood, while yin deficiency and blood dryness always worsen itching, and damp-heat invading also easily causes blood stasis; hence raw Rehmannia and Moutan clear heat and cool blood, combined with Angelica and red peony to nourish yin and moisten dryness, enrich blood and invigorate blood—both supplementing damaged yin-blood and controlling the warm-drying nature of the wind-dampness herbs; raw Dragon bone settles fright and calms the spirit, astringes and secures, and prevents the dispersing herbs from scattering too much; licorice harmonizes all the herbs.
Case 2: Patient, male, age 4, first seen January 4, 2013.
Widespread red papules for 3 years, worse for 6 days. The child had a 3-year history of eczema; since age 1, pale red maculopapules had appeared on the skin all over the body, with scratch marks, itching, rough skin, and scaling, worsening every early spring and seriously affecting life. Hormone ointments had been used without improvement. On presentation: pale red maculopapules visible on the limbs and trunk, with scratch marks, rough skin, lichenification, yellow complexion and sparse hair, slightly thin build, poor sleep, fair appetite, normal bowels, pale tongue with thin white greasy coat, weak pulse. This was due to spleen deficiency with damp accumulation, blood deficiency generating wind-dryness. Treatment: fortify the spleen and dry dampness, enrich blood and dispel wind. Formula: Baohe Wan combined with Siwu Tang, modified. Prescription: Poria (Fuling) 10g, Atractylodes (Baizhu) 10g, prepared Rehmannia (Shudi) 10g, Angelica (Danggui) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Banxia) 10g, Scutellaria (Huangqin) 10g, Magnolia bark (Houpo) 10g, Amomum (Sharen) 10g, Atractylodes (Cangzhu) 10g, Phellodendron (Huangbai) 10g, Achyranthes (Niuxi) 10g, Dioscorea hypoglauca (Bixie) 6g, roasted Coix (Yiyiren) 10g, Sophora flavescens (Kushen) 10g, Arnebia (Zicao) 10g, raw Rehmannia (Shengdi) 10g, Moutan bark (Danpi) 10g, white peony (Baishao) 10g, red peony (Chishao) 10g, Schizonepeta spike (Jingjisui) 5g, Saposhnikovia (Fangfeng) 6g, cicada slough (Chantui) 6g, licorice (Gancao) 3g. Second visit (January 11, 2013): after medication, rash color lightened, itching lessened, sleep peaceful, appetite gradually improved, stools somewhat dry. The previous formula minus raw Rehmannia, plus radish seed (Laifuzi), hemp seed (Huomaren), and peach kernel (Taoren) 10g each, was continued for 7 doses. Third visit (January 18, 2013): body rashes markedly reduced and gradually receding, no oozing, other rashes crusted, no new lesions, itching markedly lessened, complexion ruddy, sleep peaceful, spirit good, appetite fair, bowels normal, pale red tongue with thin coat. The previous formula minus Sophora and Schizonepeta spike was continued for 4 weeks to consolidate. Follow-up over the next 2 months showed no severe recurrence, no oozing or ulceration, ruddy complexion, fair appetite and sleep, and regular bowel and bladder function. Note: TCM holds that chronic eczema in children is often due to congenital spleen-stomach weakness, no source for generating qi and blood, qi-blood insufficiency causing poor blood flow, blood deficiency generating internal wind, and ying-wei disharmony. Or it may arise from later chronic illness and mistreatment damaging the spleen and stomach, causing spleen transport failure and lack of qi-blood source; or improper feeding damaging the spleen and stomach, with water-dampness stopping internally and damp-heat accumulating. Blood deficiency generates internal wind; spleen deficiency leaves damp-heat lingering in the body; wind, damp, and heat combine and erupt outward on the skin as chronic eczema. Wan Quan stated in Youke Fahui: "Man takes the spleen and stomach as root, which must be regulated; children's spleen is often deficient, so regulation is especially indispensable." Hence the treatment principle was to fortify the spleen and dry dampness, enrich blood and dispel wind, using Baohe Wan combined with Siwu Tang, modified. In the formula, Poria and Atractylodes fortify the spleen and boost qi, transporting and transforming water-dampness; prepared Rehmannia and Angelica nourish yin and moisten dryness, enrich blood and invigorate blood; Pinellia and tangerine peel move qi and resolve stagnation, fortify the spleen and harmonize the stomach; Magnolia bark, Amomum, and Coix fortify the spleen and descend qi, harmonizing the center and draining dampness; Sophora and Phellodendron clear heat and resolve toxicity, dry dampness and stop itching; Dictamnus and Fraxinus bark (Qinpi) clear heat and dry dampness, resolve toxicity and stop itching; raw Rehmannia and white peony nourish and moisten dryness, enrich blood and invigorate blood; Moutan and red peony clear heat and cool blood, fortify the spleen and descend qi; Achyranthes and Dioscorea hypoglauca fortify the spleen and leach dampness, leading dampness downward; Saposhnikovia and cicada slough dispel wind and stop itching. Combined, the herbs address qi, dampness, food, and heat together, achieving both blood enrichment and blood invigoration, so that the spleen is fortified, dampness transformed, blood enriched, and wind removed.
Baohe Wan is also very widely used in adult digestive tract diseases. Inflammatory lesions such as various gastritis, esophagitis, enteritis, pancreatitis, cholecystitis, and hepatitis can all cause indigestion and reactions such as abdominal distention, acid regurgitation, abdominal pain, diarrhea, or constipation. With proper pattern differentiation, treating them with Baohe Wan can also produce immediate results. Diseases such as reflux esophagitis usually require at least several dozen days of treatment with Western acid suppressants, but with Baohe Wan the course can be shortened to about a week. Baohe Wan and its modified version Yueju Baohe Wan both provide good relief for the series of uncomfortable symptoms caused by digestive tract ulcers.
In addition, Baohe Wan also has good efficacy on fatty liver and other digestive diseases. Ouyang Liang et al. treated 47 fatty liver patients with modified Baohe Wan, and the results showed that Baohe Wan had outstanding efficacy on fatty liver. Baohe Wan is also a frequently used medicine in diabetic patients; when diabetic patients develop gastroparesis, treating them with Baohe Wan gives very good results.
Tumor patients undergoing surgery and chemoradiotherapy often experience poor appetite, indigestion, abdominal distention and acid regurgitation, nausea and vomiting; using modified Baohe Wan to treat such patients can also effectively relieve their clinical symptoms.