Zhu Danxi's Yi Tan Wan (Phlegm-Restraining Pill)
In the Danxi Xinfa there is a formula called Yi Tan Wan (Phlegm-Restraining Pill). It is composed of: Gualouren (Trichosanthes seed) one liang (30 g), Banxia (Pinellia) two qian (6 g), Beimu (Fritillaria) three qian (9 g). Preparation: grind the three herbs into a fine powder, make into a medicinal cake, steam it, and form into pills the size of a hemp seed (mung bean). Take 100 pills each time, washed down with fresh-ginger decoction, twice daily.
This formula clears heat and transforms phlegm. It treats congealed phlegm-heat obstructing the interior, blocking the throat and making the chest-diaphragm unsmooth, so that food cannot be swallowed quickly. Gualouren in the formula clears and transforms dry phlegm; Beimu clears heat and transforms phlegm; Banxia dries dampness and transforms phlegm. All three are phlegm-transforming herbs; combined, their phlegm-transforming power is strong.
Gualouren is the seed of Trichosanthes kirilowii of the gourd family. TCM holds that Gualouren drains fire and moistens dryness, nourishes yin and moistens the lung, transforms phlegm and stops cough; it also helps stop cough and move the stool, and can disperse welling-abscesses and sores. But Gualouren has a laxative side effect, so those with spleen deficiency and loose stools should not use it. Modern pharmacology shows that Gualouren has expectorant, antiarrhythmic, myocardial-oxygen-consumption-reducing, anti-myocardial-ischemic, vascular-smooth-muscle-relaxing, coronary-dilating, coronary-blood-flow-increasing, anti-platelet-aggregation, lipid-lowering, anti-gastric-ulcer, anti-tumor, antibacterial and anti-hypoxic actions.
Because this formula heavily uses Gualouren, its indication is patients who have both phlegm and heat, and it is especially suitable for those with dry, bound stools. Gualouren’s action of broadening the chest and freeing the diaphragm is beyond the reach of other phlegm herbs. TCM chest-diaphragm unsmoothness resembles the chest oppression of cor pulmonale in modern medicine, caused by coronary blockage; Gualouren can improve coronary blood flow, and so works. Gualou was also one of Zhang Zhongjing’s main herbs for treating “chest impediment” (heart disease) in the Han dynasty; Zhang’s Guizhi Gualou Xiebai Tang is the representative formula for chest impediment.
Banxia is also quite strong in transforming phlegm and promoting diuresis. But Banxia is pungent, warm and drying; used in this formula it can moderately balance the coldness of Gualouren and Beimu. The Beimu here may be chosen, as appropriate, as Chuan Beimu (Fritillaria cirrhosa) or Zhe Beimu (Fritillaria thunbergii). Chuan Beimu is stronger at clearing heat and moistening the lung; Zhe Beimu is slightly better at dissipating phlegm and scattering nodules. Thus, if we want to use this formula for phlegm-heat cough and panting, use Chuan Beimu; if we want to dissipate phlegm and scatter nodules, use Zhe Beimu. Choose the type of Beimu according to the treatment aim.
Raw Banxia is highly toxic; in a pill, even a tiny dose can be lethal. Therefore, in preparing this formula, the herbs must first be ground, made into a cake and steamed before being formed into pills. The formula may also be taken as a decoction: use Gualouren 15 g, Fabanxia (prepared Pinellia) 3 g, Beimu 4.5 g — the adult daily dose, reduced for children.