Xiao Ban Qing Dai Yin: An Adjuvant for Purpura, Cancer Fever, and Leukemia

Xiao Ban Qing Dai Yin (Indigo Drink for Dispelling Macules) was a famous historical formula for macules (purpura) in warm disease, and it is included in many medical works.

The “Xiao Ban Qing Dai Yin” in Shanghan Liu Shu (Six Books on Cold Damage) is composed as follows: Qingdai (indigo naturalis) 5 qian (15g), Huanglian (Coptis) 5 qian (15g), Zhizi (Gardenia) 3 qian (9g), Sheng Shigao (raw gypsum) 1 liang (30g), Zhimu (Anemarrhena) 3 qian (9g), Xijiao (rhinoceros horn, now replaced by water buffalo horn, ground to powder and taken in infusion) 3 qian (9g), Shengdihuang (raw Rehmannia) 3 qian (9g), Xuanshen (Scrophularia) 3 qian (9g), Chaihu (Bupleurum) 3 qian (9g), Renshen (Ginseng) 3 qian (9g), and Gancao (Glycyrrhiza) 1 qian (3g). Method: add an appropriate amount of ginger and jujube, decoct in water, and take with one spoonful of vinegar mixed in. For dry hard stool, remove Renshen and add Dahuang (Rheum).

The “Xiao Ban Qing Dai Yin” in Yangmao Wenzheng Lun (On Wool-Fever Syndromes) is composed as follows: large Shengdihuang (raw Rehmannia) 2 liang (60g, pressed for juice); rhinoceros-horn tip 3 qian (9g, now replaced by water buffalo horn, ground to powder and taken in infusion); Huanglian 1 qian (3g); Xuanshen 5 qian (15g); raw Shigao 1 liang (30g); Zhimu 8 qian (24g); Shanzhizi 2 qian (6g); Chaihu 8 fen (2.4g); Gancao 2 qian (6g); raw Dahuang 1 qian (3g); Qingdai 1 qian (3g); and honey 5 qian (15g). Except for the Rehmannia, which is pressed for juice, decoct the rest in water; mix the Rehmannia juice with the decocted liquid and drink.

The “Xiao Ban Qing Dai Yin” in Pianyu Xinshu (Book of Jade Tablets for the Heart) is composed of Huanglian, Gancao, Shigao, Zhimu, Chaihu, Shanzhiren (i.e., Zhizi), Xuanshen, Shengma (Cimicifuga), Shengdihuang, Huangqin (Scutellaria), Renshen, and Qingdai. When decocting, add 3 slices of ginger and 20 fermented soybeans as guides, and decoct in water.

The “Xiao Ban Qing Dai Yin” in Wankui Chunqiu (Eternal Splendor of Myriad Diseases) is composed of Chaihu, Xuanshen, Huanglian, Zhimu, Shigao, Qingdai, Shengdihuang, Shanzhi (i.e., Zhizi), Xijiao, Renshen, and Gancao.

The “Xiao Ban Qing Dai Yin” in Mazhen Jicheng (A Comprehensive Collection on Measles) is composed of Qingdai, Chuanhuanglian, Zhimu, Jiansheng (raw Rehmannia), Zhizitan (charred Gardenia), Xuanshen, and Gancao.

The original texts of the above three (several) formulas do not specify dosages, which the physician must weigh.

The indications of these formulas are basically similar, namely the TCM pattern called “yang-exuberance causing macules.” The common symptoms of this pattern are purpura on the skin, even ulceration; the patient is feverish and thirsty, restless and agitated; some patients have constipation, while others vomit. TCM explains this pattern as the heat pathogen having already penetrated inward (to the Yangming), with blood heat not dispersing and the heat qi, taking advantage of the deficiency, emerging through the skin to form macules—mild cases like measles, severe cases like brocade patterns, and still more severe cases ulcerating. In other words, punctate or patchy purpura appears on the skin, which traditional TCM calls eruption or maculation.

The above symptoms appear in infectious-disease patients when the heat has entered the blood level; they appear in advanced leukemia patients; and they may also appear during cancer fever in other cancer patients (especially those in whom secondary leukemia has been induced).

How should one treat the yang-exuberance macule pattern? Xiao Ban Qing Dai Yin offers a good therapeutic approach: this pattern must be treated mainly with heat-clearing and fire-purging herbs. Qingdai, Huanglian, Zhizi, Xuanshen, Zhimu, Shengdihuang, Shigao, and Xijiao (water buffalo horn) are all TCM heat-clearing and fire-purging herbs, either of great coldness or of cold nature. Chaihu, Shengma, and fermented soybeans are relatively mild exterior-releasing herbs; because the patient has fever, one uses Chaihu, Shengma, and soybeans to release the exterior and reduce fever. Such patients are usually also weak, so tonifying herbs such as Renshen and Gancao are also needed. When internal heat is exuberant and the stool is bound up, Renshen cannot be used, because it would worsen constipation; instead, Dahuang is used to unblock the bowels and purge heat.

Although the “Xiao Ban Qing Dai Yin” in the above books differs slightly in composition, the treatment basically follows the above approach. This formula is named after Qingdai because Qingdai plays an irreplaceable role in it. The indigo (indigotin) and indirubin contained in Qingdai not only inhibit common pathogens—Bacillus anthracis, Klebsiella pneumoniae, Shigella, Vibrio cholerae, Staphylococcus aureus and albus, Salmonella typhi, and Mycobacterium tuberculosis—but also have an antileukemic effect; Qingdai is a commonly used Chinese medicine for treating leukemia. Isatis root (Banlangen) and daqing leaves (Daqingye) may also be added, as their actions are similar to those of Qingdai.