Small Formula Series 1: Xiǎo Bàn Xià Tāng

Some of the least known formulas in the Shang Han Lun, Treatise on Damage from Cold,
are  tiny, 2-herb formulas.  When I taught the course on Knotty Diseases, I was not surprised to find out that most practitioners did not know about the formula Gān Cǎo Gān Jiāng Tāng.  Perhaps the most commonly known 2-herb classic formula is Sháo Yao Gān Cǎo Tāng.  Jié Gěng Tāng and Zhī Zǐ Chǐ Tāng are also somewhat commonly known.

The wonderful benefit of studying these teeny tiny formulas is that they can teach us so much about how more complex formulas work.  For example, understanding Sháo Yao Gān Cǎo Tāng tells us so much about an aspect of Guì Zhī Tāng and especially Guì Zhī Jiā Sháo Yao Tāng.  This is true of Guì Zhī Gān Cǎo Tāng and Gān Cǎo Gān Jiāng Tāng.  We see that larger formulas are made up of the teeny tiny formulas.

So, I thought I would do a seriesof posts on the eensy weensy formulas from the Shang Han Lun and Jin Gui Yao Lue.

There are actually 3 separate formulas that contain only Pinellia and Ginger and these are the ones we’ll start with.  The first is Xiǎo Bàn Xià Tāng and then there is Bàn Xià Gān Jiāng Sān and finally Shēng Jiāng Bàn Xià Tāng. Why would Zhang Zhong Jing have THREE formulas that include only these two herbs? et’s see if we can figure that out

Before I share what I’ve translated about these formulas, let’s take note that these two herbs are in so many classic formulas.  Bàn Xià Xiè Xīn Tāng, Xiǎo Chaí Hú Tāng, Wen Jing Tāng and Huáng Qín Jiā Bàn Xià Shēng Jiāng Tāng are just a few examples.  So as you read this material consider the function of this pair in these formulas.

This post is on

小半夏汤Xiǎo Bàn Xià Tāng (Minor Pinellia Decoction)

Case 1: Stomach Cough

Patient Wang, age 27. The pulse was deep and there was shortness of breath and severe coughing. The stool was viscous and like diarrhea. This was cold damp obstructing and soaking the Yang Ming stomach. The Ying and Wei lost harmony. The chest was obstructed as if shut. This was none other than the Yang loosing its spiraling motion. The midnight Yin was in power so that the turbidity flooded upward. Should one use the method to induce vomiting? Treating cough through the lungs is not the meaning of the Nei Jing’s symptom of stomach cough.  With stomach cough, there is rebellious cough with vomiting. Xiǎo Bàn Xià Tāng with Jiāng Zhī was used.

叶天土:《临证指南医案》上海人民出版注第1版1976年7片)

Case 2: Vomiting

Patient Chen, male, age 53.

Hospital # 72395. Due to Chronic stomatitis accompanied by polyps, on October 22, 1973, he underwent a stomach resection. After the surgery he developed bile type vomiting. This continued for more than 70 days during which he could not eat. He relied on intravenous nutrition to maintain his life. Each time he vomited there was a large amount of bitter water (bile). On December 21 he had a second surgery to loosen and separate adhesions. However the vomiting did not resolve. He took旋覆代赭汤Xuán Fù Daì Zhě Tāng, Xie Xin Tang and Zuo Jin Wan with modifications to boost the Qi, nourish the Yin, generate fluids and harmonize the stomach but there was no effect. On January 4, 1974 he took Xiǎo Bàn Xià Tāng with Rén Shēn.

This was decocted down in 40 milliliters of water and divided into two doses.

After one package, the bitter water had clearly diminished. He was given 5 more packages. There was no more vomiting. He was able then to eat.

Jiang Jian-Qiu张剑秋医案，(录肉哥上海中医药杂志) 4: 24, 1979

Discussion

There are three clauses relating to Xiǎo Bàn Xià Tāng in the Jin Gui Yao Lue. Two of the clauses relate to vomiting. Generally speaking, vomiting is due to rebellious stomach Qi. The stomach follows a downward path, receiving and downbearing. When the stomach is without harmony or downbearing, the Qi rebels upward.  This is why vomiting arises. This vomiting is the upward rebellion of the stomach Qi and is due to propping fluids in the epigastric area. When water and fluids stop in the epigastric area, the stomach is restricted and is unable to receive food. As Zhong Jing said, “When there is vomiting, grains cannot go downward.” These words describe this pattern. This refers to vomiting and hiccups as well. This can also be due to stomach Qi deficiency or phlegm blockage. Zhong Jing said, “When there is vomiting, Xiǎo Bàn Xià Tāng is the principle formula. It can move phlegm, downbear rebellion and harmonize the stomach Qi.

Let us consider this formula: Shēng Bàn Xià is in an important position. It is pungent, warm and without toxin. It transforms phlegm, dispels fluids, downbears rebellion, stops vomiting and harmonizes the stomach. It is the chief herb. Shēng Jiāng assists the chief herb in dispelling phlegm and down bearing rebellion. It is also able to control an intense toxin. It is the assistant herb. These two herbs cooperate with each other and strengthen the effect of downbearing rebellion, stopping vomiting and stopping cough. This is a well-organized ancient and simple formula that is also very effective. When I use this formula I generally use prepared Bàn Xià. If the vomiting is severe, one can also use 4.5 – 6 gm of Shēng Bàn Xià cooked with 9 gm of Shēng Jiāng. This will ameliorate any worry of side effects. In addition, this formula is the foundational stop vomiting formula. It is in Zhong Jing’s formulas such as Bàn Xià Xiè Xīn Tāng, Xiǎo Chaí Hú Tāng and Huáng Qín Jiā Bàn Xià Shēng Jiāng Tāng. Later generation formulas include this combination as well such as Wēn Dàn Tāng and Èr Chén Tāng. These formulas all use Bàn Xià and Shēng Jiāng. It is just as Yin Li-Wen said in his classic医宗金鉴Golden Mirror of the Medical Tradition says “The warmth of Bàn Xià and Shēng Jiāng are able to harmonize the stomach Qi. Their pungent nature is able to disperse rebellious Qi. It is the efficacious herb combination for habitual vomiting.” However, when all is said and done, this formula tends toward being warm and drying and so it is used for vomiting without thirst and with a white sticky tongue moss and a tendency to cold fluids. For this it is suitable.

In case 1 the presentation included shortness of breath, cough, vomiting and poor appetite. The pulse was deep. This was a stomach cough. The Su Wen: Treatise on Cough says, “When there is the symptom of a stomach cough, there is cough and vomiting.” Xiǎo Bàn Xià Tāng transforms phlegm and stops cough, while down bearing rebellion and harmonizing the stomach. Adding Jiāng Zhī further warms and scatters cold fluids. Zhong Jing said “Cough rebellion with leaning over to breath, shortness of breath with an inability to lay down is what is called propping fluids.” He also said, “ when there is habitual vomiting…with lack of thirst and propping fluids below the heart, Xiǎo Bàn Xià Tāng governs.” It is clear that Xiǎo Bàn Xià Tāng treats pathological presentations that include shortness of breath with rebellious cough, accompanied by vomiting and that this is what the Su Wen calls “Stomach Cough.” Zhong Jing calls this “Propping Fluids.”

In case 2, after 70 days of being unable to eat with ceaseless vomiting, the stomach Qi was greatly damaged. Therefore Xiǎo Bàn Xià Tāng was used to downbear rebellion and stop vomiting. Bíe Zhi Shén was added to rescue the stomach Qi. The case history does not include any information regarding pulse and tongue. This is the only problem in this otherwise perfect case. Although it is not in the case, we can imagine that the pulse would be deep and weak and that the tongue would be pale with sticky moss.