Three Formulas from the Secret Records of the Orchid Chamber for Nasal Obstruction
The Secret Records of the Orchid Chamber (Lanshi Micang) is a work by Li Dongyuan. In this book there are three formulas for treating "nose unable to distinguish fragrance from stench" or "nasal congestion": one is called Lizi Tongqi Tang (Liz Airing-the-Qi Decoction), one Wenfei Tang (Warming-the-Lung Decoction), and one Yuhan Tang (Cold-Repelling Decoction).
Lizi Tongqi Tang: treats the nose's inability to distinguish fragrance from stench. Ingredients: Astragalus (Huangqi) 12 qian; Atractylodes (Cangzhu), Notopterygium (Qianghuo), Angelica Pubescentis (Duhuo), Saposhnikovia (Fangfeng), Cimicifuga (Shengma), and Pueraria (Gegen), above each 9 qian; prepared Licorice (Zhi Gancao) 6 qian; Ephedra (Mahuang, nodes not removed; added in winter), Sichuan pepper (Chuanjiao), and Angelica Dahurica (Baizhi), above each 3 qian. When used, the above herbs are made into a coarse powder. Each time take 5 qian, decoct with 3 slices of Ginger, 1 Jujube, and 3 cun of scallion, and take warm. Avoid wind and cold, and avoid raw and cold foods. Note that Ephedra is used only in winter; do not add this herb in spring and summer. However, in the author's view, in severe nasal obstruction it can also be added in spring and summer.
Wenfei Tang: treats the nose's inability to distinguish fragrance from stench, with abundant eye discharge and tearing. Ingredients: Clove (Dingxiang) 2 fen; Saposhnikovia (Fangfeng), prepared Licorice (Zhi Gancao), Pueraria (Gegen), and Notopterygium (Qianghuo), above each 3 qian; Cimicifuga (Shengma) and Astragalus (Huangqi), above each 6 qian; Ephedra (Mahuang, nodes not removed) 12 qian. When used, the above herbs are also made into a coarse powder; decoct in two bowls of water with 3 scallions down to one bowl, remove the dregs, and take after meals. Although the Secret Records of the Orchid Chamber does not note dietary contraindications for this formula, judging from the fact that it uses mostly acrid-wind-cold-scattering herbs, patients should also be required to avoid wind and cold and avoid raw and cold foods.
Yuhan Tang: treats the syndrome in which cold qi and wind evil injure the skin and hair, causing nasal congestion, cough, and upward wheezing. Ingredients: Coptis (Huanglian), Phellodendron (Huangbai), and Notopterygium (Qianghuo), above each 2 fen; prepared Licorice (Zhi Gancao), Gnaphalium (Foercao), Tussilago (Kuandonghua), Angelica Dahurica (Baizhi), and Saposhnikovia (Fangfeng), above each 3 fen; Cimicifuga (Shengma), Ginseng (Renshen), and Tangerine Peel (Chenpi), above each 5 fen; Atractylodes (Cangzhu) 7 fen; Astragalus (Huangqi) 1 qian. When used, it is also required to make a coarse powder; decoct two bowls of water down to one bowl and take after meals. Yuhan Tang does not need Jujube, scallion, or Ginger to be decocted together.
Of Li Dongyuan's three formulas, the first two are mainly acrid-warm and even use Ephedra, showing that Li's treatment of rhinitis with "nose unable to distinguish fragrance from stench" mainly approaches it from wind-cold, hence using acrid-warm exterior-releasing formulas to scatter wind-cold; once wind-cold is gone, the lung orifices open, and the blocked nose naturally clears. According to the TCM principle of "use heat and stay away from cold," taking acrid-warm cold-scattering formulas naturally requires avoiding wind and cold and avoiding raw and cold foods.
Lizi Tongqi Tang treats only the nose's inability to distinguish fragrance from stench, with no other symptoms. But Wenfei Tang, besides the nose's inability to distinguish fragrance from stench, also has "abundant eye discharge and tearing," that is, excessive tears and eye secretions. From a modern medical perspective, this belongs to the syndrome of increased inflammatory eye discharge caused by a relatively severe upper respiratory tract infection. If it continues to develop, the patient may even have symptoms of otitis media—itchy, painful, or purulent ear canals and discomfort of the Eustachian tube. Therefore Wenfei Tang adds Clove; the aromatic substances in Clove not only have an anti-infective effect but also refresh and brighten the senses.
If the patient, after contracting cold qi and wind evil, has not only nasal obstruction but also cough and upward wheezing, the first two formulas are not appropriate, and one must further use Yuhan Tang, which uses heat-clearing herbs such as Coptis and Phellodendron. This is because, according to TCM theory, after contracting wind-cold, patients mostly transform heat after a period of time; at this point it is a mixture of cold and heat, with more heat than cold. Treatment must use both the wind-cold-scattering Notopterygium, Angelica Dahurica, and Saposhnikovia, and heat-clearing herbs like Coptis and Phellodendron. However, the author feels that Phellodendron here might be better replaced by Scutellaria. Nasal obstruction plus cough and wheezing indicates the gradual appearance of pulmonary infection symptoms, and Scutellaria treats lung heat better than Phellodendron.
The above three formulas embody the spirit of TCM pattern differentiation and treatment. In modern medical terms, the three formulas Li Dongyuan created have clear indications and clear medication contraindications and are the crystallization of his clinical practical experience.