A Famous TCM Formula Commonly Used in Spring for Miscellaneous Diseases: Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction)

Spring is a season of lingering cold amid warming temperatures. After a long autumn and winter, the rainy season gradually arrives, and the air humidity rises day by day. This season sees many diseases of mixed cold and heat, and the humid air also triggers various chronic, old ailments.

Chaihu Guizhi Tang is a formula I commonly use in spring for treating various miscellaneous diseases. As long as the patient's main symptoms are grasped, it usually gives good results. Chaihu Guizhi Tang is a formula from Shanghan Lun (Treatise on Cold Damage), formed by combining half doses of Xiaochaihu Tang and Guizhi Tang into one formula, hence the name.

The prescription and dosage I commonly use for Chaihu Guizhi Tang are as follows:

Guizhi (Ramulus Cinnamomi) 6g, Baishao (Radix Paeoniae Alba) 6g, Huangqin (Radix Scutellariae) 6g, Renshen (Radix Ginseng, or Dangshen, Radix Codonopsis) 6g, Zhigancao (Honey-fried Radix Glycyrrhizae) 3g, Fabanxia (Prepared Pinellia) 7g, Dazao (Fructus Jujubae) 3 pieces, Shengjiang (Rhizoma Zingiberis Recens) 6g, Chaihu (Radix Bupleuri) 12g.

Article 146 of Shanghan Lun records: "After six or seven days of cold damage, with mild aversion to cold, vexing pain in the joints and limbs, slight nausea, a binding sensation below the heart, and the external symptoms not yet resolved, Chaihu Guizhi Tang governs."

In other words, the indications for Chaihu Guizhi Tang are: six or seven days after cold damage, slight aversion to cold, vexing pain in the limbs and joints, slight nausea and stomach upset, glomus and fullness below the heart, distending discomfort around the ribs, irritability, and accompanying fever.

In practice, the range of application of Chaihu Guizhi Tang is far broader than this single line suggests. Guizhi Tang treats Taiyang wind-strike, while Xiaochaihu Tang treats Shaoyang syndrome.

As long as there are some symptoms of Shaoyang syndrome and Taiyang wind-strike syndrome, and various difficult, complicated illnesses are triggered by spring's capricious warm-cold climate, Chaihu Guizhi Tang can be used; one need not be bound by the original text.

I will illustrate the use of Chaihu Guizhi Tang with several stubborn, complicated cases I treated with it this spring.

Case 1:

Zhang, female, born 1980, a teacher at a university in Jinan.

The patient developed allergic rhinitis after graduating with her master's degree in 2006, especially pronounced in spring and autumn. She suspected it was caused by renovation pollution in the school laboratory during her graduate years. She underwent more than ten years of Chinese and Western medical treatment without effect.

Last autumn (2017), after another allergic attack, she came to Beijing for a face-to-face consultation. Based on her pulse at the time (left deep and weak, right wiry and thin) and symptoms (runny nose, sneezing, dry mouth, bitter taste, bad breath, hot and restless sensation, constipation, swollen gums, etc.), I prescribed Yunü Jian (Jade Woman Decoction):

Shudi (prepared Rehmannia) 30g, Shengshigao (raw gypsum) 30g, decocted first, Zhimu (Anemarrhena) 6g, Maidong (Ophiopogon) 15g, Huainixi (Achyranthes) 6g.

After three doses, most of her symptoms disappeared, so she continued for a week and stopped when all symptoms were gone.

This spring, after an argument with her family, emotional anger damaged her liver, and she developed amenorrhea; the amenorrhea in turn triggered the allergy. She went to a hospital on her own to fill the prescription I had given last year, but it did not work.

Another TCM doctor at the hospital volunteered himself, claiming he specialized in allergic diseases and had been recruited into Shandong Province as an outstanding talent for his research in this field. He prescribed a TCM formula for her to take.

Following his prescription, she took the medicine, but it grew worse and worse—gradually her nose became almost completely blocked, with incessant runny nose and sneezing; menstruation stopped; her mouth was bitter and dry; her eyes were unbearably itchy; her nose swelled and her face became puffy and deformed. She came back to me.

I told her to first take Jiawei Xiaoyao Wan (Modified Free and Easy Wanderer Pills) to address the amenorrhea. After six days, her menstruation came. I then told her to stop during her period, and after her period take Chaihu Guizhi Tang—prescribed exactly as the original formula.

After two doses, her symptoms were greatly reduced, her face became clear and refreshed, and she looked like a new person. I told her to continue until symptoms were gone.

Note that although this is the same patient with the same disease, different seasons, different triggers, different weather conditions, and different accompanying symptoms call for completely different prescriptions.

At her first visit it was autumn, the weather was dry, and she presented a full picture of yin deficiency with effulgent fire, so Yunü Jian could nourish kidney yin and drain stomach heat. Once kidney water was sufficient and stomach heat removed, the internal fire was extinguished, and the allergic rhinitis symptoms caused by lung and stomach heat naturally disappeared.

Her second visit came in spring, the season when the liver channel is in command. She had exuberant liver fire, constrained heat in the liver channel, and had also contracted wind-cold—mixed cold and heat, with the Shaoyang evil unable to be expressed. Therefore Chaihu-series formulas were appropriate; after considering the cause, prescribing Chaihu Guizhi Tang was naturally effective.

From this case we can also see that TCM treatment of disease, if one treats the disease without thoroughly examining the patient's cause—like that colleague who claimed to specialize in allergic diseases and pursued so-called "special formulas for special diseases"—has little future.

Many patients read medical case records online and recklessly take the prescription some doctor gave another similar patient. Not only may it fail, it may cause serious side effects; one must be very careful.

Case 2:

My respected mentor, due to long hours of desk work, has long had cervical spondylosis. Last summer it flared after excessive air conditioning; I gave him Gegen Tang granules and brought it under control. This spring, living in Hainan where mornings and evenings are cool, noon is hot, and winds are strong, the symptoms recurred. After Gegen Tang granules on their own failed, he asked me to prescribe.

He felt dry fire in the stomach, neck and shoulder pain, aching limbs, palpitations and irritability, and insufficient center qi. Based on his symptoms, I judged this to be a combined Taiyang and Shaoyang Chaihu Guizhi Tang pattern, and prescribed the original Chaihu Guizhi Tang.

After a week, symptoms were greatly relieved. I told him to stop when nearly well, or to follow up with Buzhong Yiqi Wan (Tonifying the Center Qi Pills).

Case 3:

My mentor's wife, a patient with allergic asthma and COPD. This spring, while living in Hainan with my mentor, and also being around young children at a kindergarten, she presumably caught a cold and developed cough and wheezing.

Her cough and wheeze are always hard to resolve and often trigger serious episodes, so she was rather worried and asked me to prescribe.

I first had her take Juhong Zhike Huatan Wan (Exocarpium Citri Rubrum Cough and Phlegm Pills), which did not help. I then decided to use Chaihu Guizhi Tang; after taking it, the cough gradually lessened. I followed up with Qingfei Tang (Lung-Clearing Decoction) and Jiawei Erchen Wan (Modified Two-Aged Pills, with added Bohe/Mentha) for recovery.

Incidentally, the dosage of Chaihu Guizhi Tang should be light rather than heavy; medication should stop once the pattern is resolved. Chaihu in the formula has long been said to "rob liver yin"; long-term use can cause dryness heat and dry cough.

Japan's Ministry of Health, Labour and Welfare once reported that Xiaochaihu Tang has a serious side effect: long-term, high-dose use can induce interstitial pneumonia.

So, except for patients with persistent high fever, where large doses of Chaihu may be used short-term, once the fever comes down the dose must be reduced to a safe level. For chronically ill, weak patients, after Chaihu-series formulas relieve the condition, the formula should be adjusted; one should not keep using more just because it worked.

Case 4:

Wang, male, a Beijing resident with stubborn rhinitis and turbinate hypertrophy. This spring, due to allergy, he developed rhinitis and cough, coughing up large amounts of white sputum every morning, and waking every night suffocated by a blocked nose. Repeated Chinese and Western medicines failed.

After taking Chaihu Guizhi Wan (the patent medicine made from the Chaihu Guizhi Tang formula) and Jiawei Erchen Wan (with added Mentha), his symptoms were markedly reduced within a day. He is continuing treatment.

Case 5:

Zhang, male, 51, a farmer from Hebei with arthritis. Since this spring he has suffered unbearable pain all over the body, a bitter taste in the mouth, irritability, fullness in the ribs, fear of wind, and no fever.

He had tried various Chinese and Western medicines without effect. Only OxyContin (oxycodone) briefly relieved the pain, but the painkillers caused severe constipation and abdominal distension; after stopping, the bone pain returned as before. He came to me.

Based on his symptoms and the seasonal pattern, I prescribed the original Chaihu Guizhi Tang. After seven doses, he felt much lighter all over; he is currently under treatment.

Case 6:

Li, male, from Weihai, Shandong, a peritoneal mesothelioma patient treated by me for years. Recently, after stopping his medicine on his own for half a year, his condition relapsed, with cancer fever and ascites, poor appetite, and a belly swollen like a drum.

Based on his symptoms, I treated him with Chaihu Guizhi Tang combined with Huangqi Fangji Tang (Astragalus and Stephania Decoction), with additions. After a week, abdominal distension was greatly reduced and the cancer fever subsided; he is undergoing further treatment.

The same formula treating completely different diseases is called in TCM "treating different diseases with the same method." It works because these diseases share the same triggers and, by TCM pattern differentiation, the same pathology.

The same disease treated with different formulas is called "treating the same disease with different methods." It is necessary because, although the patient appears to have the same disease—even the same patient—different seasons and triggers produce different patterns, so different treatments are required.

In the examples above, the Jinan patient Zhang and my mentor had the same disease, but because the relapse occurred in different seasons, their prescriptions differed; they are classic examples of treating the same disease with different methods.

So TCM efficacy is hard-won. Only by studying more, memorizing more, thinking more, working diligently in the clinic, and accumulating experience can one respond flexibly and relieve patients' suffering.