Xiao chai hu tang
chai hu 24 huang qin 9 ban xia 12 ren shen 9 sheng jiang 9 da zao 9
zhi gan cao 6
This has got to be the most popular formula in the modern clinic, it certainly is in mine.
But why is it the representative formula for a shao yang pattern.
Understanding xiao chai hu tang is understanding the balance between the yang and yin levels and the imperial and ministerial fire.
Shao yang patterns are the most common because all weakness of the imperial fire weakens the ministerial fire. The imperial fire is the true fire and water of the body. When this becomes weak there arises unrest in the kingdom.
The unrest that arises in the kingdom causes accumulations such as dampness and phlegm and a flaring of the ministerial fire due to stagnation. Look for cold hands and feet, hot flashes, a stool that is alternating hard and soft, a sore throat, dizziness, and mental vexation.
There are different causes of this weakness of the imperial fire. It is often caused by a tai yang wind strike pattern that has progressed internally. It can also be caused by taxation where yin fails to contain yang which then becomes overabundant and reckless. It is certainly the most common pattern seen in modern clinics.
Let’s take a look at the difference between the imperial fire and the ministerial fire. The imperial and ministerial are one Fire with different qualities. The imperial Fire is more static and stable. The ministerial Fire is more circulatory and supportive.
We can compare the imperial fire to the sun.
The yang qi of the body is like the sun. If the sun loses its brilliance or illuminating effect, all things on earth become inactive. The sun is the ultimate yang. Ch 3 Neijjing suwen.
It is the same for the emperor of a land. As a secondary climatic qi it is called heat because it can never be excessively warm.
The job of the minister is to bring the message from the emperor to the people. As a secondary climatic qi it is called fire because it can change in intensity. If too hot it burns tissues. If too cool it fails to support the bodily functions in all three burners.
The ministerial fire is only hot when it stagnates.
Xiao chai hu tang is considered a harmonizing formula because it clears the accumulation of excess as in damp and phlegm but also the heat that arises due to stagnation while supporting the weakness that gives rise to the accumulation in the first place. It clears problems in the shao yang level while tonifying and moistening the tai yin, shao yin and jue yin levels.
It allows the ministerial fire to once again freely circulate in all three burners supplying the warmth and nutritive to the organs and surface.
By freeing the ministerial fire it allows the clear qi formed from food qi to rise up through the tai yin to the 100 vessels as true qi which can then protect, warm and nourish the surface and body.
Chai hu frees jue yin liver blood needed to support the Earth and Metal.
Huang qin clears the congestion in the jue yin liver and shao yang gall bladder and the yang ming stomach domain.
Chai hu relieves the surface of wind heat evils and frees the body from evils that have entered the shao yang realm and have transformed into heat.
Huang qin is a qi layer heat clearing herb, it also clears internal heat in the shao yang and yang ming channels. It clears internal gall bladder heat that flares up to the upper burner. It also clears san jiao damp heat through its bitter drying taste and cold cooling nature.
Together they clear the congestion on the surface and interior of the shao yang realm.
Chai hu, huang qin are shao yang herbs. Ban xia, ren shen, sheng jiang, da zao and zhi gan cao are the magik five.
Ban xia forms part of the magik five. The magik five tonifies tai yin and clears phlegm accumulation in the stomach, yang ming domain, lung and chest.
Ban xia dries Earth dampness, it transforms damp phlegm and disperses qi stagnation. It moves qi in yang ming and transforms phlegm and dampness in tai yin spleen and lung.
This formula works on all levels at once.
chai hu clears heat congestion on the surface, sheng jiang warms the surface
huang qin clears damp and heat in the stomach domain, ban xia dries dampness and moves qi in the stomach, sheng jiang tonifies and disperses excess fluids in the stomach, zhi gan cao tonifies stomach while moistening
chai hu clears damp and heat in the san jiao, huang qin clears damp and heat from the san jiao, gall bladder
ban xia tonifies, warms and dries spleen and lung, ren shen tonifies spleen and lung while moistening, sheng jiang tonifies and warms spleen and lung and sends clear qi upwards, da zao tonifies spleen while moistening, zhi gan cao tonifies spleen while moistening
ren shen tonifies original qi, zhi gan cao nourishes heart blood
huang qin clear damp and heat from the liver, da zao nourishes blood
Modifications from line 96 of the Shang han lun
When in cold damage that has lasted for five or six days or wind strike, there is alternating aversion to cold and heat effusion, the person suffers from fullness in the chest and rib side, taciturnity with no desire for food and drink, heart vexation and frequent retching, or possibly there is vexation in the chest and no retching, or thirst or pain in the abdomen, or a hard glomus under the rib side, or palpitations below the heart with inhibited urination, or absence of thirst with mild generalized heat, or cough, then xiao chai hu tang governs.
If there is vexation in the chest without retching, remove ban xia and ren shen and add gua lou shi.
Ban xia treats retching and if this is absent it is ok to remove and replace with herbs that will treat the vexation which is due to excessive heat rising to the chest. Ren shen replaces lost fluids to help contain reckless yang qi and gua lou shi cools heat, opens the chest and flushes out accumulations.
If there is thirst remove ban xia and add more ren shen and add gua lou gen.
Ban xia is drying and this will cause more thirst. Ren shen moistens taiyin fluids and gua lou gen or tian hua fen clears heat while moistening.
If there is pain in the abdomen remove huang qin and add bai shao.
Huang qin is very cold and very bitter so the pain must be caused by dryness in Earth. Bai shao moistens yin and blood so the Metal element can once again descend. We see the combination of chai hu and bai shao in the small formula si ni san. The chai hu treats the yang level of shao yang and the bai shao treats the yin level of jue yin.
If there is a hard glomus under the ribs remove da zao and add muli.
Da zao moistens and this creates more dampness which can make the glomus worse. It is the muli which makes it clear that the glomus is from dampness because muli is salty and the taste of salt softens hardness.
If there are palpitations below the heart with inhibited urination remove huang qin and add fu ling.
Huang qin is drying and this can cause the shao yin heart to become even more weak. When the imperial fire is weak water can surge upwards causing palpitations. Fu ling promotes urination to clear excessive water.
If there is no thirst and mild generalized heat remove ren shen and add gui zhi, and take the decoction till a slight sweat occurs.
Adding gui zhi will treat the surface and mild generalized heat if due to tai yang wind strike. Gui zhi is creating more Wood wind to clear the surface of cold and ren shen would hold this dispersing back with its yin fluid generating nature.
If there is cough remove ren shen, da zao and sheng jiang and add wu wei zi and gan jiang.
If the cough is due to excessive fluids in the lung then the ren shen and da zao which create fluids will make it worse. The sheng jiang is not drying enough and is replaced with gan jiang which is much more drying. Wu wei zi will correct the counter flow qi of the lung with its sour collecting nature.
Once the balance between the yang and yin levels has been cleared then you can proceed to tonifying and nourishing the yin levels.
Xiao chai hu tang puts the emperor back on his throne.