The Four Detoxification Decoctions Veteran Physician Zhao Bingnan Frequently Used
The late Dr. Zhao Bingnan was the towering authority of TCM external medicine in China; before his death he served as director of dermatological and external medicine at the Beijing Hospital of Chinese Medicine. He left behind many empirical formulas, among which four are named Detoxification Decoctions, all effective remedies for external diseases. This article presents these four formulas selected by Dr. Zhao.
Detoxification Heat-Clearing Decoction (Jiedu Qingre Tang): dandelion (Pugongying) 1 liang; wild chrysanthemum (Yejuhua) 1 liang; isatis leaf (Daqingye) 1 liang; Viola (Zihuadiding) 5 qian; Paris rhizome (Zaoxiu) 5 qian; Trichosanthes root (Tianhuafen) 5 qian; red Peony (Chishao) 3 qian.
This formula clears heat and resolves toxicity. It is used for deep-rooted boils (ding), furuncles (jie), welling abscesses (yong), the initial stage of acute erysipelas, and the onset of any superficial infection. In the formula, dandelion, wild chrysanthemum, Viola, and Paris rhizome all belong to heat-clearing, toxicity-resolving herbs; among them dandelion additionally reduces swelling and disperses nodules; Paris rhizome reduces swelling and pain and also stops bleeding; Trichosanthes root clears heat and drains fire, drains pus and reduces swelling, and is a common TCM herb for welling abscesses; red Peony cools blood and reduces swelling. Used together, these herbs are especially suitable for the early stage of superficial infections in various dermatological and surgical conditions. The formula may also be used for leukemia and allergic purpura presenting with the above symptoms.
Detoxifying Nutritive-Level Decoction (Jiedu Qingying Tang): honeysuckle (Jinyinhua) 5 qian–1 liang; forsythia (Lianqiao) 5 qian–1 liang; dandelion (Pugongying) 5 qian–1 liang; dried rehmannia (Shengdi) 5 qian–1 liang; Imperata rhizome (Baimaogen) 5 qian–1 liang; raw hawksbill shell (Sheng Daibao) 3 qian–5 qian; Moutan (Mudanpi) 3 qian–5 qian; red Peony (Chishao) 3 qian–5 qian; Coptis (Huanglian) 1 qian–3 qian; mung bean coat (Lvdouyi) 5 qian–1 liang; Madder root (Qiancogen) 3 qian–5 qian; raw Gardenia (Sheng Zhizi) 3 qian–4 qian.
This formula clears the nutritive level and resolves toxicity, cools blood and protects the heart. It is used for furuncles and abscesses with intense swelling, pain, heat, and toxin; for dual flaring of qi and nutritive levels; and for the early stage of toxemia caused by any pyogenic infection.
When external diseases are in the infectious stage, TCM often sees toxin-heat invading the nutritive blood level, with high fever, irritable thirst, and even clouded consciousness. Dr. Zhao's empirical formula combines half a dose of Honeysuckle and Forsythia Powder (Yinqiao San) with half a dose of Coptis Detoxification Decoction (Huanglian Jiedu Tang), adding blood-cooling, swelling-reducing, heat-clearing, diuretic herbs such as Moutan, Imperata rhizome, red Peony, and mung bean coat; it thus both reduces fever and reduces swelling and pain. Adding raw hawksbill shell both clears heat and resolves toxicity and pacifies the liver, extinguishes wind, and sedates the spirit, suiting the condition well.
Detoxifying Blood-Cooling Decoction (Jiedu Liangxue Tang): buffalo horn (Shuiniujiao) 5 qian–1 liang (the original formula used rhinoceros horn, now banned, so buffalo horn is substituted); rehmannia charcoal (Shengditan) 5 qian–1 liang; honeysuckle charcoal (Shuanghuatan) 5 qian–1 liang; lotus plumule (Lianzixin) 3 qian–5 qian; Imperata rhizome (Baimaogen) 5 qian–1 liang; Trichosanthes root (Tianhuafen) 5 qian–1 liang; Viola (Zihuadiding) 3 qian–5 qian; raw Gardenia (Sheng Zhizi) 2 qian–4 qian; Paris rhizome (Zaoxiu) 5 qian–1 liang; raw licorice (Sheng Gancao) 2 qian; Coptis (Huanglian) 3 qian; raw gypsum (Shigao) 2 qian–4 qian.
This formula clears the nutritive level, cools blood, and resolves toxicity. It is suitable for infectious dermatological-surgical diseases at the stage when toxin-heat has already entered the nutritive blood—equivalent to the modern stage of sepsis.
Detoxifying Yin-Nourishing Decoction (Jiedu Yangyin Tang): American ginseng (Xiyangshen) 1 qian–3 qian; northern and southern Glehnia (Bei'nan Shashen) 5 qian–1 liang; Dendrobium (Shihu) 5 qian–1 liang; Scrophularia (Xuanshen) 5 qian–1 liang; Finger citron (Foshou) 5 qian–1 liang; raw Astragalus (Sheng Huangqi) 3 qian–5 qian; dried rehmannia (Shengdi) 5 qian–1 liang; Salvia (Danshen) 3 qian–5 qian; honeysuckle (Jinyinhua) 5 qian–1 liang; dandelion (Pugongying) 5 qian–1 liang; "two winters" (Tiandong and Maidong) 3 qian–6 qian; Solomon's seal (Yuzhu) 3 qian–5 qian.
This formula suits external diseases at the stage when toxin-heat has damaged qi and yin, with vital qi already injured but toxin-heat not yet fully resolved—equivalent to the late stage of septicemia. The patient is weary and fatigued, with dry throat and thirst and poor appetite; at this point, using too many pathogen-expelling herbs would exceed the patient's stamina. Therefore treatment should mainly support vital qi, with toxicity-resolving heat-clearing as secondary; this formula therefore heavily uses TCM yin-nourishing herbs—American ginseng, Glehnia, Dendrobium, Scrophularia, rehmannia, the "two winters," and Solomon's seal. But while supporting vital qi one must not forget to expel pathogen, so honeysuckle and dandelion are added to clear heat and resolve toxicity, Salvia to cool blood and reduce swelling, and Finger citron to regulate qi and unblock stagnation, so that the patient's spleen and stomach are not overwhelmed by bitter-cold herbs.
Dr. Zhao's four formulas actually treat four different stages of the same category of disease. These diseases are common in TCM external medicine, collectively called "yang welling abscesses"—infectious conditions causing redness, swelling, heat, pain, fever, dry mouth, and constipation; some cancer patients also present with such symptom clusters. To treat such yang abscesses, one must determine, from the patient's specific condition, which stage he is in; only then can the correct formula be chosen to resolve the patient's problem.