Class 9 : Herbs and Formulas That Release The Exterior

1. Class 9: Herbs and Formulas That Release The Exterior Fayi Wu

2. Warm-Acrid Release Exterior Herbs • Herba Ephedrae (Ma huang) • Ramulus Cinnamomi (Gui zhi) • Folium Perillae (Zi su ye) • Herba Schizonepetae (Jing jie) • Radix Ledebouriellae (Fang feng) • Radix Notopterygii (Qiang huo) • Radix Angelicae Dahuricae (Bai zhi) • Herba Asari (Xi xin) • Rhizoma Zingiberis Recens (Sheng jiang) • Herba Elsholtziae (Xiang ru) • Flos Magnoliae (Xin yi hua) • Bulbus Allii Fistulosi (Cong bai)

3. Herba Ephedrae (Ma huang) • Taste and Nature: Pungent, slightly bitter and warm • Channel tropism: Lung and bladder • Actions: induces sweating, calms wheezing, promotes urination • Indications: • Treat exterior syndrome of wind-cold type. • Facilitate outward flow of lung qi to relieve asthma. • Induce diuresis to treat edema due to affection of wind. • Dosage: 6-10g. • Contraindications: • Being strong in inducing sweating, this herb is not applicable to patients with spontaneous sweating due to qi deficiency, especially in the aged, very young patients and those with a weak constitution. • Exciting the central nervous system, it is used carefully in patients with hypertension, insomnia and fidget • When treating chronic cough, it should be given intermittently, otherwise its effectiveness will be lowered.

4. Ramulus Cinnamomi (Gui zhi) • Taste and Nature: Pungent, sweet and warm • Channel tropism: Heart, lung and bladder • Actions: induces sweating and releases exterior, warms and unblocks the channels and collaterals, and assists the yang • Indications: • Treat exterior syndrome of deficiency type with symptoms of wind-cold type. • Relieve pain by dispersing wind cold from the channels and collaterals, applicable to pain or soreness in the shoulder and lumbar region. • Assist yang to promote flow of yang qi and remove obstruction from the collaterals, applicable to phlegm syndrome, abdominal pain due to yang deficiency and dysmenorrhea due to accumulation of cold in the collaterals. • Dosage: 3-9g • Contraindications: Pregnancy, Menorrhagia, Deficiency heat syndrome. • Common compatible herbs: • Gui Zhi and Bao Shao: Regulate ying and wei, applicable to exterior syndrome of deficiency type and insomnia, palpitation, • Gui Zhi and Bai Zhu: Promote flow of yang qi to treat retention of water in the bladder marked by dysuria,

5. Folium Perillae (Zi su ye) • Taste and Nature: Pungent, aromatic and warm • Channel tropism: Lung and spleen • Actions: releases exterior and disperses cold, promotes the movement of qi and expands the chest, resolves seafood poisoning • Indications: • For wind cold. • Prevention of common cold. • Cool-dry syndrome. • For vomiting caused by stagnation of cold and qi in the stomach. • Prevent miscarriage by promoting flow of qi. • Eliminate Toxin: Applicable to poisoning of crabs or cancers. • Dosage: 3-9 g, not decoct too long. • Comments: • Using the stem for chest depression, Su Ye for exterior syndrome. • Being aromatic in taste, it has a strong property of moving about. So, it is specially applicable to vomiting or exterior syndromes with qi stagnation manifestations. • When used for relieving poisoning, its dosage should be up to 30-60 g. • Diabetics should not take the herb at a large dosage, since it can increase the blood sugar level.

6. Herba Schizonepetae (Jing jie) • Taste and Property: acrid, slight warm • Meridian Tropism: liver and lung • Actions: releases the exterior and dispels wind, vents rashes and alleviates itching, stops bleeding • Indications: • For exterior patterns of either wind-cold or wind-heat. Also for carbuncles or boils when they first erupt, especially when accompanied by chills and fever. • For initial stage of measles and pruritic skin eruptions. • As an auxiliary herb for hemorrhage. • Dosage: 4.5-9g • Contraindications: deficiency of the exterior, fully erupted measles or open sores.

7. Radix Ledebouriellae (Fang feng) • Taste and Property: acrid, sweet, slight warm • Meridian Tropism: bladder, liver and spleen • Actions: releases the exterior and expels wind; expels wind-dampness and alleviates pain; expels wind relives spasm • Indications: • For headache, chills and body aches due to externally-contracted wind-cold. • For exterior wind-damp painful obstruction (bi syndrome), especially when wind predominates, used with qiang huao, dang gui. • As an auxiliary herb to alleviate trembling of the hand and feet and tetany. • Dosage: 4.5-9g • Contraindications: exuberant fire from yin deficiency, spasm from blood deficiency

8. Radix Notopterygii (Qiang huo) • Taste and Property: acrid, bitter, aromatic, warm • Meridian Tropism: bladder, kidney • Actions: releases the exterior and expels wind, cold, dampness; unblocks painful obstruction and alleviates pain • Indications: • For headache, chills and body aches due to externally-contracted wind-cold. • For wind-cold-damp painful obstruction, especially in upper limbs and back. • Dosage: 3-9g • Contraindications: for blood deficiency painful obstruction

9. Bulbus Allii Fistulosi (Cong bai) • Taste and Nature: Acrid, warm • Channel tropism: Lung and stomach • Actions: releases exterior and induces sweating; disperses cold and unblocks the yang, resolves toxicity and disperses clumps • Indications: • For exterior syndrome of wind cold, especially in the very early stages, used with dan dou chi, i.e. cong chi tang • For either abdominal pain and distention or nasal congestion due to blockage of yang qi by cold, i.e. bai tong tang • For sores and abscesses, externally as a poultice • Dosage: 3-9g. • Contraindications: profuse sweating from exterior deficiency, can’t taken with honey

10. Scallion and Prepared Soybean Decoction (cong chi tang) Ingredients: cong bai, dan dou chi

11. Actions and indications of the formula • Actions • Unblocks the yang qi in the exterior and induces sweating • Indications • Mild fever and slight chills without sweating, headache, stuffy nose, a thin white tongue coating and a floating pulse.

12. Analysis of Formula • Cong bai: • A warm, acrid herb that unblocks the flow of yang qi in the exterior and induces sweating • Dan dou chi: • Releases externally contracted disorders from the exterior as well as interior constraint

13. Modern application and modifications • Modern application: • Disorder of upper respiratory tract infection • Modifications: • For pronounced chills and headache, add qiang huo, fang feng, jing jie • For pronounced cold with abdominal pain, add sheng jiang, brown sugar

14. Ephedra Decoction (ma huang tang) Ingredients: ma huang, gui zi, xing ren, gan cao

15. Actions and indications of the formula • Actions • Releases exterior cold and arrests wheezing. • Indications • Fever and chills (chills predominant) without sweating, headache, generalized body aches, wheezing, a thin white tongue coating, and floating tight pulse .

16. Analysis of Formula • Chief: Ma huang • Disseminates the lung qi and treats wheezing. • Deputy: Gui zhi • Releases the exterior (especially the muscle layer) and warms and facilitates the flow in the channels. Combined with chief herb, it strengthens the diaphoretic effect. • Assistant: Xing ren • Unblocks the flow of lung qi and helps the chief ingredient arrest wheezing and expel the pathogenic influence . • Envoy: Gan cao • Harmonizes the actions of the other herbs and moderates the diaphoretic action of ma huang

17. Modern application and modifications • Modern application: • Disorder of upper respiratory tract infection, influenza, acute bronchitis, bronchial asthma, lobar pneumonia and acute glomerulonephritis. • Attentions: • Contraindicated for patients with debility and copious urination, and for patients who are prone to bleeding, used with caution in cases with hypertension. • Modifications: • For exterior cold with interior heat, add shi gao • For sore throat, reduce the dosage of gui zhi, add tian hua fen, she gan.

18. Cinnamon Twig Decoction (gui zhi tang) Ingredients: gui zhi, shao yao, sheng jiang, da zao, gan cao

19. Actions and indications of the formula • Actions • Releases pathogenic influences from the muscle layer and regulates the nutritive and protective qi. • Indications • Fever and chills unrelieved by sweating, headache, aversion to wind, stiff neck, nasal congestion, dry heaves, no particular thirst, a thin white tongue coating, and floating pulse that is either moderate or frail. May also be used for a similar presentation in patients recovering from serious illness or after childbirth.

20. Analysis of Formula • Chief: Gui zhi • Releases externally-contracted wind-cold from the muscle layer. • Deputy: bai shao yao • Benefits the yin and contains the weak nutritive qi. Combined with chief herb, enhance protective qi to dispel pathogenic influences while strengthening the nutritive qi. • Assistant: sheng jiang, da zao • Sheng jiang: helps the chief herb release the exterior while also treating the nausea and vomiting • Da zao: helps deputy nourish and harmonize the nutritive qi and blood • Envoy: Gan cao • Tonifies middle burner and harmonizes the actions of the other herb

21. Modern application and modifications • Modern application: • Disorder of upper respiratory tract infection, influenza, post partum fever, allergic rhinitis, angioedema, cerebrovascular spasm, eczema and urticaria. • Attentions: • Contraindicated in cases with exterior cold and interior heat. • Modifications: • For marked nasal congestion with sneezing, add fang feng, xin yi hua • For shortness of breath and rough breathing, add hou po, xing ren • For severe vomiting, increase the dosage of sheng jiang and bai shao, add chen pi, hou po • For joint pain in the extremities accompanied by fatigue, add qiang huo and fang feng

22. Minor Bluegreen Dragon Decoction (xiao qing long tang) Ingredients: ma huang, gui zhi, gan jiang, xi xin, wu wei zi, bai shao, ban xia, zhi gan cao

23. Actions and indications of the formula • Actions • Releases the exterior, transforms congested fluids, warms the lungs, and directs rebellious qi downward. • Indications • Fever and chills (chills predominant) without sweating, coughing, wheezing, sputum that is copious, white, stringy, and difficult to expectorate, a stifling sensation in the chest, a generalized sensation of heaviness and body aches, no particular thirst, a moist tongue coating, and a floating, tight pulse. In severe case, there may be edema or considerable difficulty in breathing when lying down

24. Analysis of Formula • Chief: ma huang, gui zhi • Ma huang: releases exterior, arrests wheezing and moves water by facilitating the flow of lung qi • Gui zhi: works with ma huang to release the exterior • Deputy: gan jiang, xi xin • Warm the interior, transform congested fluids, and help the chief herbs release the exterior. Gan jiang also can warm spleen, xi xin also stops the cough by facilitating the flow of qi through the body • Assistant: wu wei zi, bai shao, ban xia • Wu wei zi: prevents the leakage of lung qi • Bai shao: nourishes the blood and nutritive qi • Ban xia: transforms congested fluids and harmonizes the stomach • Envoy: Gan cao • Augment the qi and harmonizes the interaction of the acrid and sour herb

25. Modern application and modifications • Modern application: • Acute bronchitis, acute exacerbation of chronic bronchitis, bronchial asthma, and influenza. • Attentions: • Should not be used long-tern, nor for conditions with heat, coughing of blood, or coughing due to yin deficiency. Use with caution in cases with hypertension • Modifications: • For severe exterior cold disorders, increase the dosage of ma huang, gui zhi • For pronounced nasal congestion, runny nose, and headache, substitute sheng jiang for gan jiang, add fang feng, jing jie

26. Nine-Herb Decoction with Notopterygium (jiu wei qiang huo tang) Ingredients: qiang huo, fang feng, cang zhu, xi xin, chuan xiong, bai zhi, huang qin, sheng di huang, gan cao

27. Actions and indications of the formula • Actions • Releases the exterior dampness and clears interior heat. • Indications • Fever and chills (chills predominant) without sweating, headache, stiff neck, generalized aches and pain, slight thirst, a bitter taste in the mouth, a white tongue coating, and a floating pulse.

28. Analysis of Formula • Chief: qiang huo • Disperses exterior wind-cold-dampness • Deputy: fang feng, cang zhu, xi xin, chuan xiong, bai zhi • Fang feng, cang zhu: assist the chief herb in releasing the exterior and eliminating dampness • Xi xin, chuan xiong, bai zhi: assist the chief herb in releasing the exterior and treating the head and body aches • Assistant: huang qin, sheng di huang • Clear qi and blood level interior heat respectively, treat the thirst and bitter taste in the mouth and also prevent the dry nature of the other herbs from injuring the fluids • Envoy: Gan cao • Harmonizes the middle burner and the actions of the other herbs

29. Modern application and modifications • Modern application: • Disorder of upper respiratory tract infection, influenza, sinusitis, acute lower back sprain, and rheumatic fever. • Modifications: • For upper back and shoulder pain, add qin jiao • For pronounced thirst and irritability, add shi gao, zhi mu • Where there is no thirst or bitter taste in the mouth, omit huang qin, sheng di huang