Herbal Medicine

Herbal Monograph for Xiao Chai Hu Tang

John Chen, PhD, PharmD, OMD, LAc

Xiao chai hu tang (Minor Bupleurum Decoction) is one of the most commonly used herbal formulas today. Historically, it was used to treat shaoyang syndrome. Today, it is used to successfully treat many disorders including hepatitis, liver fibrosis, liver cancer, jaundice, cholecystitis, cholelithiasis, pancreatitis, nephritis, acute tonsillitis, parotitis, stomatitis and many more. To achieve optimal therapeutic outcome, it is of critical importance to learn beyond the traditional aspect of this formula. Understanding of topics such as pharmacological effect, clinical studies and research, toxicology and herb-drug interactions will greatly empower the practitioners to properly select the best herbal formula for treatment. Listed below is the herbal monograph on Xiao chai hu tang (Minor Bupleurum Decoction), an excerpt from Chinese Herbal Formulas and Applications by John and Tina Chen, to be published by Art of Medicine Press in fall, 2007.

Xiao Chai Hu Tang (Minor Bupleurum Decoction)
Pinyin Name: Xiao Chai Hu Tang
Literal Name: Minor Bupleurum Decoction
Alternate Names: Hsiao Tsai Hu Tang, Minor Bupleurum Combination
Original Source: Shang Han Lun (Discussion of Cold-Induced Disorders) by Zhang Zhong-Jing in the Eastern Han Dynasty

Composition

Chai Hu (Radix bupleuri)	24g [12g]
Huang Qin (Radix scutellariae)	9g [9g]
Ban Xia (Rhizoma pinelliae), xi (washed)	0.5 cup [9g]
Sheng Jiang (Rhizoma zingiberis recens), qie (sliced "Slicing")	9g [9g]
Ren Shen (Radix et rhizoma ginseng)	9g [6g]
Zhi Gan Cao (Radix et rhizoma glycyrrhizae praeparata cum melle)	9g [5g]
Da Zao (Fructus jujubae), bo (opened)	12 pieces [4 pieces]

Dosage/Preparation/Administration

The source text specifies to cook the ingredients in 12 cups [2400 mL] of water until 6 cups [1200 mL] of the liquid remain. Discard the residue and cook the strained decoction again until it is reduced to 3 cups [600 mL]. Take 1 cup [200 mL] of warm decoction per dose, three times daily. Today, the decoction may be prepared using the dosages suggested in brackets.

Chinese Therapeutic Actions

Harmonizes shaoyang

Clinical Manifestations

Shaoyang syndrome: alternating spells of fever and chills, chest and hypochondriac fullness and discomfort, irritability, a bitter taste in the mouth, lack of appetite, nausea, vomiting, vertigo, a dry throat, a thin, white tongue coating and a wiry pulse.
Any of the following disorders with shaoyang characteristics: gynecological disorders with heat in the uterus, liver or chong (thoroughfare) channel; malaria; jaundice; or any internal injury characterized by shaoyang syndrome.

Clinical Applications

Hepatitis, viral hepatitis, chronic hepatitis, hepatic fibrosis and carcinoma, hepatocellular carcinomas, jaundice, cholecystitis, cholelithiasis, pancreatitis, fever, fever in cancer, nephritis, chronic renal insufficiency, acute tonsillitis, infectious parotitis, stomatitis, common cold, influenza, measles, bronchitis, pneumonia, pulmonary tuberculosis, cough, allergic rhinitis, bronchial asthma, reflux esophagitis, antral gastritis, gastritis, gastric pain, gastric prolapse, constipation, Meniere's syndrome, dizziness, seizures, migraine, angina, depression, chronic fatigue syndrome, morning sickness, postpartum infection, postpartum fever, dysmenorrhea, premenstrual syndrome and malaria.

Explanation

Xiao chai hu tang (Minor Bupleurum Decoction) is the main formula for harmonizing shaoyang syndrome, one of the six stages of disease progression described in Shang Han Lun (discussion of cold-induced disorders). The shaoyang is situated between yang and yin, or between the exterior and interior; therefore, alternating spells of fever and chills may occur in shaoyang syndrome if the body is fighting both the pathogens outside and the disharmony inside.

Disorders in the shaoyang might cause qi stagnation and eventual heat formation in the gallbladder channel (a shaoyang channel), giving rise to chest and hypochondriac fullness and discomfort, a bitter taste in the mouth, vertigo, a dry throat and irritability. Lack of appetite, nausea and vomiting are the results of gallbladder heat invading the stomach. The tongue coating is thin and white because the pathogenic factors have not yet transformed into internal heat. The wiry pulse is the result of qi stagnation in the shaoyang channel.

Because the disease resides between the exterior and the interior, it is not suitable to use only exterior-releasing herbs or only purgative herbs. Use of only exterior-releasing herbs will not treat the interior condition, and use of only heat-clearing or downward-draining herbs will bring the pathogens from the exterior into the interior. Therefore, the harmonizing method is the most appropriate treatment approach in this condition.

Chai hu (Radix bupleuri) is the main herb for treating shaoyang disorders. The light quality of chai hu (Radix bupleuri) lifts and disperses stagnation, as well as releases to the exterior. Huang qin (Radix scutellariae), a bitter and cold herb that enters the gallbladder channel, is ideal for clearing shaoyang heat. Together, chai hu (Radix bupleuri) disperses the exterior while huang qin (Radix scutellariae) clears the interior to achieve the harmonizing effect. Ban xia (Rhizoma pinelliae), besides harmonizing the stomach to relieve nausea and vomiting, disperses stagnation in the body. Sheng jiang (Rhizoma zingiberis recens) helps ban xia (Rhizoma pinelliae) harmonize the middle jiao. It also reduces the toxicity of ban xia (Rhizoma pinelliae). Ren shen (Radix et rhizoma ginseng), zhi gan cao (Radix et rhizoma glycyrrhizae praeparata cum melle), and da zao (Fructus jujubae) tonify stomach qi, nourish body fluids and harmonize the ying (nutritive) and wei (defensive) levels. The combination of chai hu (Radix bupleuri) and ren shen (Radix et rhizoma ginseng) also provides a mutual check and balance for each other: chai hu (Radix bupleuri) prevents the tonic effect of ren shen (Radix et rhizoma ginseng) from retaining the pathogens in the body, while ren shen (Radix et rhizoma ginseng) prevents the dispersing effect of chai hu (Radix bupleuri) from damaging qi. Combined, these herbs expel the pathogens and strengthen bodily constitution.

Because the shaoyang stage is unstable and often short and transient, the symptoms listed above may not be clinically present all at the same time. Therefore, as suggested in shang han lun (discussion of cold-induced disorders), this formula can be applied even if there is only one shaoyang symptom clinically present.

Xiao Chai Hu Tang (Minor Bupleurum Decoction)
Diagnosis	Signs and Symptoms	Treatment	Herbs
Shaoyang syndrome	Alternating spells of fever and chills: the location of the illness between exterior and interior. Chest and hypochondriac fullness and discomfort: qi stagnation. A bitter taste in the mouth, a dry throat, and irritability: heat in the shaoyang gallbladder channel. Lack of appetite, nausea, and vomiting: gallbladder heat invading the stomach. Thin, white tongue coating: exterior condition. Wiry pulse: qi stagnation.	Harmonizes shaoyang	Chai hu (Radix bupleuri) releases the exterior, and huang qin (Radix scutellariae) clears the interior. Together, they harmonize shaoyang disorders. Ban xia (Rhizoma pinelliae) harmonizes the stomach to relieve nausea and vomiting, and disperses stagnation. Sheng jiang (Rhizoma zingiberis Recens) harmonizes the middle jiao. Ren shen (Radix et rhizoma ginseng), zhi gan cao (Radix et rhizoma glycyrrhizae praeparata cum melle), and da zao (Fructus jujubae) tonify Stomach qi, nourish body fluids, and harmonize the ying (nutritive) and wei (defensive) levels.

Modifications

General Signs and Symptoms:

If accompanied by headache, add chuan xiong (Rhizoma chuanxiong).
If there is thirst, remove ban xia (Rhizoma pinelliae) and add tian hua fen (Radix trichosanthis).
With thirst and irritability from deficiency in heat, add mai dong (Radix ophiopogonis) and wu wei zi (Fructus schisandrae chinensis).
If there is no thirst but a slight fever and exterior symptoms are present, remove ren shen (Radix et rhizoma ginseng) and add gui zhi (Ramulus cinnamomi).
With irritability, add dan zhu ye (Herba lophatheri) and geng mi (Semen oryzae).
With more irritability but absence of nausea or vomiting, remove ban xia (Rhizoma pinelliae) and ren shen (Radix et rhizoma ginseng) and add gua lou (Fructus trichosanthis).
With abdominal pain, remove huang qin (Radix cutellariae) and add bai shao (Radix paeoniae alba).
With more vomiting or nausea, add sheng jiang (Rhizoma zingiberis recens) and chen pi (Pericarpium citri reticulatae).
When there is indigestion in children, add bai zhu (Rhizoma atractylodis macrocephalae), chen pi (Pericarpium citri reticulatae), fu ling (Poria) and shan zha (Fructus crataegi).
If there is gum pain caused by yin deficiency, add shi gao (Gypsum fibrosum).
With palpitations and dysuria, remove huang qin (Radix scutellariae) and add fu ling (Poria).
With distention and hardness of the hypochondriac area caused by phlegm accumulation, remove da zao (Fructus jujubae) and add mu li (Concha ostreae).
If the hypochondriac pain is severe, add qing pi (Pericarpium citri reticulatae viride), bai shao (Radix paeoniae alba) and xiang fu (Rhizoma cyperi).
With a stifling sensation in the chest, add zhi shi (Fructus aurantii immaturus) and qing pi (Pericarpium citri reticulatae viride).

Infectious Disorders:

For common colds, add jing jie (Herba schizonepetae), fang feng (Radix saposhnikoviae) and ge gen (Radix puerariae lobatae).
For influenza, add jin yin hua (Flos lonicerae japonicae), lian qiao (Fructus forsythiae) and ban lan gen (Radix isatidis).
For acute bronchitis, add jie geng (Radix platycodonis), zhi qiao (Fructus aurantii), ku xing ren (Semen armeniacae amarum) and bai bu (Radix stemonae).
For chronic bronchitis, add fu ling (Poria), chen pi (Pericarpium citri reticulatae), zi wan (Radix et rhizoma asteris) and kuan dong hua (Flos farfarae).
For acute otitis media, add long dan (Radix et rhizoma gentianae) and zhi zi (Fructus gardeniae).
For urinary tract infection, add bian xu (Herba polygoni avicularis), che qian cao (Herba plantaginis) and hai jin sha (Spora lygodii).
For malaria, add chang shan (Radix dichroae), bing lang (Semen arecae) and wu mei (Fructus mume).

Liver and Gallbladder Disorders:

For icteric jaundice and hepatitis, add zhi shi (Fructus aurantii immaturus), yin chen (Herba artemisiae scopariae), bai shao (Radix paeoniae alba) and jin qian cao (Herba lysimachiae).
For damp-heat jaundice, add yin chen (Herba artemisiae scopariae), zhi zi (Fructus gardeniae) and ban lan gen (Radix isatidis).
For jaundice with more heat, add zhi zi (Fructus gardeniae) and huang bo (Cortex phellodendri chinensis).
For jaundice resulting from hepatitis or cholecystitis, add zhi shi (Fructus aurantii immaturus), yin chen (Herba artemisiae scopariae), bai shao (Radix paeoniae alba) and jin qian cao (Herba lysimachiae).

Gynecological Disorders:

For postpartum wind invasion with perspiration, remove chai hu (Radix bupleuri).
For postpartum wind invasion without fever, remove huang qin (Radix scutellariae).
For postpartum wind invasion with increased vomiting or nausea, increase the dosage of sheng jiang (Rhizoma zingiberis recens).
For postpartum wind invasion with marked deficiency, increase the dosage of ren shen (Radix et rhizoma ginseng).
When there is wind invasion during the menstrual period, add niu xi (Radix achyranthis bidentatae), tao ren (Semen persicae) and mu dan pi (Cortex moutan).

Cautions/Contraindications

Xiao chai hu tang should be used with caution in patients of yin and/or blood deficiencies, in patients of upper excess and lower deficiency, or in patients of liver fire. Inappropriate use of this formula may result in headache, dizziness or bleeding gums.
In general, there is no sweating associated with relief of symptoms following the administration of Xiao chai hu tang, since it harmonizes, rather than releases the exterior. However, some patients do show sweating prior to recovery. They should be monitored closely to prevent excessive sweating from injuring yin.
Avoid cold, raw, pungent and spicy foods while taking this formula.¹

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Editor's Note: Part 2 of this article will appear in the August 2007 issue of Acupuncture Today.

July 2007