Professor Yin Huihe's Experiential Formula for Biliary Tract Disease: Modified Da Chaihu Tang
Biliary tract diseases belong to the Shaoyang syndrome in Chinese medicine and are usually treated with formulas from the Chaihu series. In clinical practice, Professor Yin Huihe, based on the clinical features of modern biliary tract diseases (such as obstructive jaundice, cholecystitis, and gallstones), modified Da Chaihu Tang (Major Bupleurum Decoction) to form an experiential formula.
The formula is as follows: Chaihu (Bupleurum Radix) 15 g, Chishao (Paeoniae Rubra Radix) 15 g, Huangqin (Scutellariae Radix) 15 g, Fabanxia (processed Pinelliae Rhizoma) 9 g, Zhiqiao (Aurantii Fructus) 9 g, Dahuang (Rhei Radix et Rhizoma) 9 g (added later), Yinchen (Artemisiae Scopariae Herba) 30 g, Yujin (Curcumae Radix) 9 g, Chuanjinqiancao (Desmodii Herba) 60 g, Pugongying (Taraxaci Herba) 30 g, Gualou (Trichosanthis Fructus) 30 g.
This formula addresses Shaoyang excess-heat syndrome caused by biliary tract disease, presenting as distending pain and tenderness in the right hypochondrium radiating to the shoulder and back, epigastric and abdominal fullness, dry stool, yellow greasy tongue coating, and wiry rapid pulse.
Da Chaihu Tang is a commonly used formula in Chinese medicine for biliary tract disease. It consists of Chaihu, Huangqin, Dahuang, Zhishi, Banxia, Shaoyao, Dazao, and Shengjiang, and has the effects of relieving pain, dispelling distention, purging the bowels, downbearing counterflow, and clearing heat. It treats combined Shaoyang and Yangming disease. Its indications include a bitter taste in the mouth, alternating chills and fever, fullness in the chest and hypochondria, vomiting, irritability, epigastric glomus, constipation or heat-associated diarrhea, yellow tongue coating, and a wiry, rapid, forceful pulse indicating liver-gallbladder damp-heat.
Professor Yin's formula adds Yinchen, Yujin, Jinqiancao, Pugongying, and Gualou to Da Chaihu Tang, strengthening the effect of soothing the liver and benefiting the gallbladder; all these herbs reduce jaundice. Biliary tract diseases are often accompanied by jaundice hepatitis, so Professor Yin's formula is more targeted. Professor Yin's experience is: for gallstones, add Jineijin (Galli Gigerii Endothelium Corneum) 9 g and Mangxiao (Natrii Sulfas) 9 g to soften hardness and dissolve stones; for biliary infection, add Wuweizi (Schisandrae Fructus) 9 g and Shandougen (Sophorae Tonkinensis Radix) 10 g to clear heat and detoxify; for cholecystitis, add Shengmuli (raw Ostreae Concha) 30 g to soften hardness and reduce swelling.
In fact, besides common biliary tract diseases such as cholecystitis, gallstones, and obstructive jaundice, tumors of the hepatobiliary system presenting the above symptoms can also be treated with this formula as a base. When treating biliary tract tumors, one may additionally add Ezhu (Curcumae Rhizoma), Sanleng (Sparganii Rhizoma), Biejia (Trionycis Carapax), Shuihonghuazi (Polygonum orientale fruit), Banzhilian (Scutellariae Barbatae Herba), Tianjihuang (Hyperici Japonici Herba), Xianhecao (Agrimoniae Herba), and Yexiazhu (Phyllanthi Urinariae Herba), with dosages adjusted to the patient's condition.
But this formula has a strong purgative effect, so it should not be used for long. Once the patient's bowels move freely, the prescription should be gradually adjusted, removing the laxative Dahuang and Mangxiao. Especially when treating chronic diseases such as tumors, Dahuang should not be used long-term, and it is best to add tonifying herbs such as Dangshen (Codonopsis), Danggui (Angelica), and Huangjing (Polygonatum), so as not to damage the patient's genuine qi (zheng qi).