Indications of Xiao Xianxiong Tang: Epigastric Fullness and Distending Pain, Chest Pain, Thick Difficult-to-Cough Phlegm, Angina, etc.

Xiao Xianxiong Tang (Minor Chest-Storing Decoction) comes from the Shanghan Lun (Treatise on Cold Damage). The original text in the Shanghan Lun reads: "In the minor chest-storing disease, the disorder is right below the heart; it hurts when pressed, and the pulse is floating and slippery; Xiao Xianxiong Tang governs it."

The original formula of Xiao Xianxiong Tang is: coptis (Huanglian) one liang, pinellia (Banxia) half a sheng (washed), one large fruit of Trichosanthes (Gualou). In modern use it is usually: whole trichosanthes 30g, Sichuan coptis 6g, processed pinellia 10g.

The characteristic signs of the Xiao Xianxiong Tang pattern are: hard fullness below the heart (epigastrium) that hurts on pressure, a floating slippery pulse, congealed phlegm-heat, thick yellow sputum, and oppressed or painful chest and diaphragm. These symptoms are commonly seen in gastritis, coronary heart disease, and chronic respiratory disease.

Trichosanthes (Gualou) in this formula clears the lung, moistens dryness, and resolves phlegm; regulates qi and loosens the chest; dissipates phlegm and disperses nodules; and moistens the intestines to unstop the bowels. It is commonly used for phlegm-heat cough, dry-phlegm cough and wheezing, chest impediment, chest-storing disease, breast abscess with swelling and pain, lung abscess, intestinal abscess, and intestinal dryness with constipation.

Coptis's main actions are to clear heat and dry dampness, drain fire, and resolve toxin. It is commonly used for damp-heat fullness and vomiting, diarrhea and dysentery, and jaundice; it can also be used for high fever and irritability or coma in febrile disease, internal heat with vexation and insomnia, stomach-fire toothache, mouth and tongue sores, liver fire invading the stomach with acid regurgitation, blood-heat vomiting of blood or nosebleed, abscesses and sores with swelling and pain, red painful eyes, furuncles in the ear canal, and damp-heat sores.

Pinellia's main actions are to dry dampness and resolve phlegm, downbear counterflow and stop vomiting, dissipate fullness and disperse nodules. It can be used for cough and wheezing with much phlegm, phlegm-rheum with dizziness and palpitations, wind-phlegm vertigo, phlegm-jue headache, nausea and vomiting from stomach qi ascending counterflow, chest and epigastric fullness and oppression, plum-pit qi, goiter and phlegm nodules, and abscesses and sores with swelling and toxin.

Combined, the three herbs clear heat and resolve phlegm, loosen the chest and regulate qi, and disperse nodules and stop pain. The ancients held that trichosanthes can be used to treat epigastric and chest-abdominal pain, even pain radiating to the back—symptoms seen in chronic diseases such as gastritis and gastric ulcer, coronary heart disease, and pulmonary obstruction. So the indications of Xiao Xianxiong Tang are broad; any of the above diseases, as long as it presents with the corresponding symptoms, may be treated with Xiao Xianxiong Tang.

This formula is also a commonly used base formula for gastric cancer and lung cancer patients. The three herbs in it—trichosanthes, coptis, and processed pinellia—all have some antitumor action. In addition, this formula also has a good stomach-strengthening effect, and works well for epigastric fullness, pain, and constipation caused by improper diet.