Yinchenhao Tang and Its Derivative Formulas for Promoting Diuresis and Relieving Jaundice

Yinchenhao Tang comes from Zhang Zhongjing's Shanghan Lun (Treatise on Cold Damage) of the Han Dynasty. The formula is composed of: Yinchenhao (Artemisiae Scopariae Herba) 6 liang (one Han-Dynasty liang converts to 15 g today), Zhizi (Gardeniae Fructus) 14 pieces, Dahuang (Rhei Radix et Rhizoma, peeled) 2 liang. Decoction method: take the above three ingredients, add 1 dou 2 sheng of water (about 1200 ml today), first boil Yinchenhao down by 6 sheng (to about 600 ml today), then add Zhizi and Dahuang and boil down to 3 sheng (about 300 ml today). Remove the dregs and divide into three doses. Urination should be promoted, the urine looking like the juice of honey locust pods, bright red in color. By the next night the abdomen will have softened, and the jaundice will exit through the urine.

The Shanghan Lun describes the indications of this formula as follows: In Yangming disease, if there is fever and sweating, this means heat is being released outward and jaundice will not develop; but if sweating occurs only on the head, stopping at the neck, with no body sweat, difficult urination, and thirst for fluids, this means heat is stagnating internally and the body will surely turn yellow; Yinchenhao Tang governs it.

According to the symptoms recorded, this disease is what we now call jaundice. It is mainly caused by a malfunction of the body's waste-processing system: the metabolite bilirubin in the blood exceeds the normal level, causing the skin, sclera, mucous membranes and body fluids to turn yellow, commonly called yellow disease.

The causes of this disease are complex and cannot be generalized; prognosis differs by cause. I have written about jaundice in detail elsewhere, so I will not repeat it here. Briefly, jaundice falls into four major categories: 1. hemolytic jaundice; 2. hepatocellular jaundice; 3. cholestatic jaundice; 4. congenital non-hemolytic jaundice; 5. neonatal jaundice. Neonatal jaundice is a special type and should be treated in pediatrics; do not self-medicate. Hemolytic jaundice is an autoimmune disease requiring inpatient treatment in the acute phase; do not manage it on your own.

The jaundice we see most often is caused by jaundice-type hepatitis, cholecystitis, gallstones, liver cirrhosis, liver cancer, hepatic metastases and similar conditions. Yinchenhao Tang is generally used for symptomatic supportive treatment of such diseases. It can relieve the clinical symptoms and even fully resolve the jaundice, but solid tumors and stones are beyond what Yinchenhao Tang can address; while using Yinchenhao Tang, the patient should also receive corresponding radical treatment.

There is a patent medicine on the market based on Yinchenhao Tang, sold under the trade name Yinzhihuang granules; the name derives from its three ingredients, Yinchen, Zhizi and Dahuang. Yinzhihuang granules spare the trouble of decocting herbs; those who find it inconvenient to decoct can buy the patent medicine directly, and in the acute phase the dose may be doubled.

Yinchenhao Tang is a classic formula with good symptomatic and supportive effects; effective patients often see immediate results. Historically, this formula has therefore spawned many derivatives. Each derivative has its own indications; studying them can improve our clinical results. The main derivatives are introduced below.

Yinchen Tang (from Beiji Qianjin Yaofang)

Yinchen (Artemisiae Scopariae Herba) and Huanglian (Coptidis Rhizoma), each 3 liang; Huangqin (Scutellariae Radix) 2 liang; Dahuang, Gancao and Renshen, each 1 liang; Zhizi 14 pieces. Decoct in water for oral use, three times a day. Action: clear and discharge damp-heat, support healthy qi and relieve jaundice. Indications: jaundice with the body, face and eyes all yellow. This formula includes Renshen because the patient is relatively weak, hence Renshen is used to support healthy qi. Compared with the base formula, it adds Huangqin, Huanglian and Gancao. Huangqin and Huanglian clear heat and resolve toxin, with broad antibacterial and antiviral effects; Gancao moderates the purgative nature of Dahuang and the bitter-cold nature of Huangqin and Huanglian, so that pathogen is driven out without damaging healthy qi.

Sanwu Yinchenhao Tang (from Waizhai Miyao)

Yinchen a handful, Zhizi 24 pieces, Shigao (Gypsum Fibrosum) 1 jin. Decoct the first two in water, remove dregs and take the juice. Roast Shigao in a fierce fire until it is bright red, then drop it into the herbal juice; once the bubbling subsides, take the clear juice and divide into two doses. Take the first dose, cover the patient with blankets to induce sweating all over the body, then dust the body with warm powder and the patient recovers; if there is no sweating, take the second dose. This formula clears heat and drains fire, promotes diuresis and relieves jaundice. Indications: jaundice with the body and eyes all yellow, and "curved dust rising from the skin." The phrase "curved dust rising from the skin" is hard to interpret and I do not understand its meaning, but judging from the heavy use of Shigao and the blanket-induced sweating method, this formula's indication is mainly jaundice accompanied by fever.

Qinjiao Tang (from Taiping Shenghui Fang)

Qinjiao (Gentianae Macrophyllae Radix), Chishao and Xijiao (rhinoceros horn, now replaced by Shuiniujiao, buffalo horn), each half a qian; Huangqin 3 fen; Chaihu (Bupleuri Radix), Yinchenhao and Maimendong (Ophiopogonis Radix), each 1 liang; Dahuang (lightly fried) 2 liang. Grind together into coarse powder; take 4 qian each time, decoct in water, 3-4 times a day, to the point of promoting urination. This formula clears heat and cools blood, promotes diuresis and relieves jaundice; it governs overstrain jaundice with heat congestion in the heart and spleen, and flesh, skin, face and eyes all yellow.

Qinjiao Tang has a stronger heat-clearing action and also uses Maimendong, a yin-nourishing herb. Zhang Zhongjing's Yinchenhao Tang does not include such yin-nourishing balancing; for chronic, lingering patients, overusing diuretic herbs damages yin, so moderate yin nourishment is needed.

Chaihu San (from Taiping Shenghui Fang)

Chaihu and Maimendong, each 1 liang; Yinchen, Xijiao (now replaced by Shuiniujiao) and Zhi Gancao, each half a qian; Biejia (Trionycis Carapax, roasted with ghee) 2 liang. This formula clears heat and drains dampness, nourishes yin and scatters nodulation. It governs overstrain jaundice with weakness of the limbs, vexing pain in the joints, occasional vomiting, inability to eat, dry nose, body heat and vexatious pain, gradual emaciation, and irregular chills and fever.

Judging from the symptoms and herbs above, Chaihu San mainly treats liver cirrhosis or advanced liver cancer already presenting with jaundice, cancer fever and cancer pain. Interestingly, it uses Biejia, an herb that softens the liver and fights liver cancer; this compositional logic is faultless even from the standpoint of modern pharmacology.

Zexie Tang (from Shengji Zonglu)

Zexie (Alismatis Rhizoma), Huangqin, Baixianpi (Dictamni Cortex), Yinchen and Ejiao (Asini Corii Colla, fried dry), each 1 liang; Zhi Gancao 3 fen. Grind together into powder; take one and a half qian each time, mixed with rice water on an empty stomach, twice a day. This formula promotes diuresis and relieves jaundice, nourishes yin and clears heat; it governs alcoholic jaundice, with accumulated heat in the five zang, red face, delirious speech, clouded confusion, and yellow color in the eyes.

From this text, the indication should be advanced alcoholic liver disease; but the delirious speech and clouded confusion suggest the patient has already developed hepatic encephalopathy. Whether this formula can relieve such severe patients, I cannot say from personal clinical experience; I reprint it for readers' reference only.

Yinchen Fuzi Ganjiang Tang (from Weisheng Baojian)

Fuzi (Aconiti Radix Lateralis, prepared, peeled and decocted) 3 qian; Paojiang (blast-fried Zingiberis Rhizoma) 2 qian; Yinchen 1 qian 2 fen; Baizhu 4 fen; roasted Cao Doukou (Amomi Rotundus Fructus) 1 qian; Fuling and Chenpi, each 3 fen; Zhishi (fried with wheat bran), Fabanxia and Zexie, each half a qian. Grind together into coarse powder; add 5 slices of Shengjiang, decoct in water, remove dregs, and take at unscheduled times. This formula warms the middle and fortifies the spleen, promotes diuresis and relieves jaundice; it governs yin jaundice, with body and eyes yellow, cold limbs and skin, glomus and hard fullness below the heart, dry eyes disinclined to open, spontaneous diarrhea with curled-up lying posture, and a deep, fine pulse.

From this derivative we can see how refined traditional TCM treatment was. Although jaundice is mostly damp-heat, some patients have a cold constitution; when such patients develop jaundice, their symptoms differ from most patients. Treating such patients must take their cold constitution into account, using warming herbs such as Fuzi, Paojiang and roasted Cao Doukou.

Fuling Shishi Tang (from Weisheng Baojian)

Yinchen 6 fen; Fuling 5 fen; Zhuling (Polyporus) and Zexie, each 2 fen; Huanglian, Huangqin, Zhizi, Hanfangji (Stephaniae Tetrandrae Radix), Baizhu, Cangzhu, Chenpi and Qingpi, each 2 fen. Grind together into coarse powder; decoct in water, remove dregs, and take on an empty stomach before meals. This formula clears heat and drains dampness, moves qi and relieves jaundice; it governs jaundice with chills and fever, vomiting, thirst for cold drinks, body, face and eyes all yellow, difficult urination, total inability to eat, and inability to lie down.

Judging from its composition, this formula treats jaundice accompanied by ascites. It uses a large number of diuretic and qi-moving herbs, suitable for patients with liver cirrhosis or liver cancer presenting with jaundice and ascites.

Taohua Huazhuo Tang (from Yichun Shengyi)

Taoren, Niuxi, Danshen and Cheqianzi (Plantaginis Semen), each 2 qian; Honghua and Jiangxiang (Ligni Dalbergiae Odoriferae), each 5 fen; Yanhusuo (Corydalis Rhizoma) and Chishao, each 1 qian; Dangguiwei (Angelicae Sinensis Radix tail) and Zexie, each 1 qian 5 fen; Yinchen 3 qian; Xueyutan (Crinis Carbonisatus) a pinch. This formula activates blood and resolves stasis, drains dampness and relieves jaundice. It governs nülau dan (overstrain jaundice from sexual excess) with urgent sensation in the bladder, fullness of the lower abdomen, blackness above the forehead, the whole body yellow, heat below the feet, and black stools occasionally loose.

Judging from its composition and indications, this formula treats jaundice with ascites in advanced liver cirrhosis and liver cancer. Today we treat such patients by similarly combining blood-activating and stasis-resolving, dampness-draining and jaundice-relieving, qi-moving and nodule-scattering, and water-promoting and swelling-reducing herbs; this formula already integrates all these approaches.

The term nülau dan here reflects the ancients' lack of understanding of the pathology of cirrhosis and liver cancer; they mistakenly thought such diseases arose from excessive sexual indulgence, hence the name. "Blackness above the forehead" is a sign that liver cancer or cirrhosis has entered the terminal stage; black and loose stools indicate internal bleeding.

The later derivatives of Yinchenhao Tang are too numerous to list exhaustively, but their developmental course through the dynasties can already be glimpsed from the formulas above. These derivatives show that our ancestors' understanding of such diseases deepened step by step, and their approach to treatment grew increasingly mature.