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Xiao Chai Hu Tang: Herbal Medicine in China Essay

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Updated: May 5th, 2022

Introduction

Herbal medicine in China has become widespread since its introduction. Many herbalists use different herbs and formulas to generate prescriptions for usage in various areas of medicine, health, and nutrition. Herbal medicine is used mainly in preserving health than treating diseases. Such medicines include supplements that aid in nurturing the body’s immune system, spirit and energy. Different types of herbs exist thus much research ought to be carried out before creating the prescription to ensure the end product has no toxicological effects on people. One or two herbs that treat the problem at hand are included while the other constituents help or assist the first two to work efficiently or treat small issues. The Xiao Chai Hu Tang (Minor Bupleurum Decoction) is a prescription formulated from Chinese herbs and used to treat various febrile diseases. The paper focuses on the mechanism and circumstances of using the Xiao Chai Hu Tang. The analysis is done on the ingredients and their subsequent modification to fit the signs and symptoms experienced.

Xiao Chai Hu Tang

The Xiao Chai Hu Tang (Minor Bupleurum Decoction) is a prescription used for treating a variety of ailments and is prepared from a mixture of very concentrated Chinese herbs. The diseases include febrile disease which is mostly associated with high fever, chills, nausea and stomach upsets; liver problems; gastritis, and so on (Benskey & Gamble, 1993). It is one of the most commonly adopted prescriptions due to its ease in modification thus making it suitable for treating a specific symptom. It is used for harmonizing the interior and exterior heats thus plummeting fever.

Mechanism

Xiao Chai Hu tang is composed of an assortment of herbs. The seven basic herbs include:

  • Chai Hu botanically known as Radix Bupleuri – Is the main component of the decoction and is primarily used for exterior heat clearance due to its diffusion effect and for clearing qi stagnation.
  • Huang Qin (Radix Scutellariae Baicalensis) – is used in assisting the Chai Hu herb in providing the harmonization effect. Huang qin acts in the interior while Chai hu acts in the exterior of the body. Jointly with Chai Hu, heat is cleared and yin fluid impairment is prevented.
  • Ban Xia (Rhizoma Pinelliae Ternatae) – used for treating nausea and vomiting when the qi has ascended.
  • Ren Sheng (Radix Ginseng) – together with Da Zao and Zhi Gan Cao, it is used for supplementing and maintaining the stomach qi so that any existing pathogens can easily be ejected.
  • Zhi Gan Cao (Radix Glycyrrhizae Praeparatae)- used for maintaining qi.
  • Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) – similar to Ban Xia, it is used for treating nausea.
  • Da Zao (Fructus Zizyphi Jujubae)- used for qi tonification.

Ban xia, Ren sheng, Sheng jiang, Zhi Gan Cao and Da zao acts as assistant drugs to the Chai hu while Huang qin acts as a deputy.

For maximum performance of the Xiao Chai Hu Tang, several factors have to be taken into consideration when selecting the formulae of the herbs to be used. These are the pharmacological and toxicology effects of the drug and the drug-herb interaction (Chen, 2007b).

Pharmacological effect

Generally, the Xiao chai hu tang exhibits various pharmacological effects (Chen, 2007a). These include:

  • Hepatoprotective- the drug prevents any damage to the liver. It aids in the prevention of diseases such as fibrosis or liver inflammation.
  • Temperature regulator.
  • Anti-tumor, allergies and ulcers.
  • Immune stimulating effect.

For the provided formula, the pharmacological effects are:

  • Temperature regulation – administration of Xiao helps in regulating the body temperature. Sporadic episodes of chills and fevers marked the symptoms of the febrile disease, thus, the prescription is very effective in maintaining the required temperature.
  • Radioprotective – the drug is able to help against any damage to the lungs which may be caused by radiation.
  • Immunostimulant- Xiao chai hu tang helps in improving the immunity of a body against frequent colds and chills and stoppage of nausea.

Drug – herb interactions

Interactions of drug-drug, drug-herb, or herb-herb have different bodily effects. Sometimes, their interaction causes a negative effect on the body while at times, positive results are achieved with drug-drug interaction producing serious consequences than drug-herb and herb-herb interactions because some herbs are ‘natural buffers’ (Carter, 1999).

Drug – herb interactions fairly produce positive results by boosting the effect of one another. Here both the western and Chinese formula is put into use. When xiao chai hu tang interacts with some drugs, assortments of signs are observed. For example, when there is an interaction with interferon, neutrophils may be overstimulated resulting in the destruction of the lung and its tissues (Chen, 2007a). When it interacts with halothane, danazol, and carbon tetrachlori, damage to the liver is prevented. Interaction of Xiao chai hu tang with P450 hampers CYP2C9 thus lowering the metabolism rate of the liver (Chen, 2007b). From the examples above, it is concluded that the herbal drug Xiao chai hu tang interacts in different ways with other western drugs either positively or negatively. Consequently, care should be taken when administering the drugs to ensure no patient is adversely affected.

Circumstances of using the Xiao Chai Hu Tang formula

The Xiao chai hu tang is used for harmonization. Various symptoms are usually visible and one can easily detect the shao yang syndrome. The shao yang syndrome manifests itself as chills and fever (Can & Cheng, 2008). Sometimes, not all symptoms are manifested but the decoction is still applicable. The syndrome appears on the outside and inside of the body and if the inside symptoms are treated leaving the outside, or vice versa, disharmonization occurs (Chanian &Yubin, 1996).

The febrile disease shows a variety of signs and symptoms, including fever, chills, distension, chest oppression, restlessness and nausea. These are signs of weakness in the immune system of a person; hence, the decoction comes in handy.

Moreover, the clinical usage of the Xiao chai hu tang comprises treating other illnesses such as diseases of the liver, influenza, gastritis, viral hepatitis, fibrosis, jaundice, tonsils, measles, bronchitis, postpartum fever, depression, asthma, premenstrual syndrome, dizziness, seizures, tuberculosis, allergic rhinitis, and etcetera (Chen, 2007a). Therefore, when a patient suffers from any of the diseases stated, the clinician may use Xiao chai hu tang to cure the disease.

Analysis of ingredients and modifications

As seen above, Xiao Chai Hu Tang is used to treat a variety of ailments. Despite this, other symptoms present themselves and the given decoction is not able to clear away the illness unless other herbs are included in the mixture. Thus formulae modification is done. The modification involves adding a particular type of herb and removing others. This is due to inhibitions when one herb counteracts the other. Since Chai Hu (Radix Bupleuri) is the main ingredient in the formula, it is seldom removed, unlike the other given ingredients.

Chest fullness but no nausea

Patients suffering from Shao yang disease display various symptoms such as chest fullness. The Ban xia and Sheng jiang are used for nausea and vomiting. Since the patient is not suffering from nausea, the herbs are removed from the mixture and the Gua lou is added.

Gua lou is a cold but sweet herb used for treating any chest problems including: removing any blockage from the diaphragm, converting any thick phlegm or sputum, soothing the chest by ensuring its expansion and dissipation of heat, clearing lungs, and etcetera. Moreover, Gau lou works together with Ren sheng to regulate qi.

The dosage for the Gua lou is 10-20g. When modifying Xiao chai hu tang for fullness of chest, 1piece or 3g of the Gua lou herb is added and together with Chai hu and Huang Qin, all qi, chest and lung problems are eliminated.

Thirst (Xiao ke)

Body fluids such as perspiration help in cooling the body and in preventing thirst and thus, to ensure that the fluids are produced effectively and are eliminated from the body, the qi must work accordingly (Chen & Chen 2004). The Gau lou gen, a cold sweet/ sour herb is used for quenching thirst or sore throats, detoxification, moistening dryness, generating body fluids, and so on. When a patient experiences thirst due to lung heat, the xiao chai hu tang is administered and is modified using the Gua lou gen. For effective clearance, a daily dosage of 10-20g is added to the decoction.

The Ren sheng daily dosage is 5-10g. Due to its nature of reducing or calming thirst by generating body fluids, its dosage is increased to match that of Gua lou. For optimal performance of the modified Xiao chai hu tang, both the Ren sheng and Gua lou are included in almost equal quantities since they complement each other. Ban Xia is eliminated from the formula since it does not aid in fluid generation but prevents vomiting.

Abdominal pain

Shao yao is common to the central interior of the stomach. As Hu (2010) states, ‘abdominal pain is found in both vacuity and repletion’. Qi pain is not intense while abdominal pain occurring due to pressure accrues and congregates. The central interior must be strengthened when abdominal pain is experienced.

The Shao yao (Radix Paeoniae Lactiflorae) is a bitter and cold herb, good at calming abdominal pain. When star fried, it helps in relieving the abdominal pain and regulating qi and blood. Its recommended daily dosage is 3-10g and the proportional dosage is 0.5 – 75%.

The huang qin helps in intestinal toxic heat clearance. Since the abdominal pain is very intensive, Huang qin is not very effective in its clearance hence the need for using Shao yao. The daily dosage for Huang qin is 3-10g, thus, when removed from the formula, an equal amount of the Shao yao herb is put since their daily dosages are similar.

Low mass on the costal margin

Mu li (Concha Ostreae) is a cool salty and astringent herb used for removing body lumps, goitre, scrofula and any hardness formed in the body. In addition, it is used for maintaining body fluids and spirit calming. It is an assistant drug to the Chai hu. It enters the body system through the liver and kidney. When used in excess, it causes constipation hence one must ensure that the right dosage is administered. The recommended daily dosage is 15-30g. The proportional dosage:

Min- 7%, max- 50%, Avg- 21.02% (TCM Assistant, 2004).

The Da zao (Fructus zizyphi Jujubae) is a sweet and neutral herb used for blood nourishment and qi tonification (envoy drug). One of the side effects of this herb is its tendency to cause dampness, bloating and indigestion of food. Due to its habit of causing food stagnation, it cannot be used in lowering the costal mass margin.. Thus it is excluded in the xiao chai hu tang prescription while the mu li which softens hard masses is included. Its daily dosage is 10-30g or 3-12pieces. Proportional dosage: 1.5%-50%. The average dosage is 8.96%. Therefore, when 12pieces or the maximum daily dosage of Da zao is removed from the decoction, an equal amount of Mu li has to be added.

Palpitation and dysuria

Fu ling (Sclerotium Poriae Cocos) is a sweet, neutral and bland herb that enters the body system via the lungs, heart and spleen. It is used for treating palpitation, dysuria, dizziness, anorexia, and so on. In addition, body dampness is reduced. The Fu ling is an assistant drug. Depending on the observable symptom on a patient, the herb can be mixed with a variety of herbs to form different mixtures. Gui zhi can also be added to the mixture since it helps in dysuria or problems with the urinary tract. Its recommended daily dosage is 10-15g with 4.5g for a single dose. Therefore, for a patient to consume three doses daily, fu ling’s dosage must be increased to 13.5g.

Huang qin clears internal heat and dries dampness but does not help in clearing palpatation and dysuria thus when preparing the decoction for a patient exhibiting dysuria and palpitation, it is omitted and the fu ling added. Its daily dosage is 3-10g. The daily dosage for the fu ling is higher than Huang qin’s, thus, when 3liang of Huang qin is removed, 4liang of Fu ling is added.

Slight exterior fever with no thirst

Patients with exterior fever need heat clearance to bring the temperature down. Gui zhi, extracted from the cinnamon plant is a warm sweet herb used mostly for warming the exterior by promoting the secretion of sweat and dispersing any cold spells experienced. In addition, the qi is able to flow effectively. It enters the body system through the heart and lungs. Its daily recommended dosage is 3-10g. The proportional dosage is between 2-66%.

When a patient does not show thirstiness, the Ren sheng is removed from the decoction since it helps in the generation of body fluids. The patient is covered with quilt for light perspiration generation because when Ren shen is used in the decoction, the sweating is a lot. Modification is done by including Gui zhi which clears the fever by reducing the exterior heat.

Cough (xiao Qing Long Tang)

The Ren sheng, Da zao and Sheng jiang are assistant drugs in maintaining the stomach qi. Moreover, Ren sheng is used for generating body fluids. When a patient is having a cough, Ren sheng has to be removed from the formulae otherwise, the cough will continuously persist.

Wu wei zi is a sour, sweet, bitter, acrid and salty herb that is commonly used in producing Chinese medicines. Due to its salty and bitter nature, it is used for kidney and lungs. A patient having fever and chills (inclusive of coughs) exhibits one external symptom, i.e. fever, with the rest being internal. In the lungs, it is used to prevent loss of the fluids and releasing exterior and interior colds. When used for coughs, the formula is termed as Xiao Qing Long Tang (Altschuler, 2008). Its recommended daily dosage is 3-6g.

Gan jiang is a hot and spicy herb used for removing colds and fluids clogged up in the lungs. It also helps in removing dampness. When combined with the Wu wei zi, fluid dispersion, collection, retaining and opening is improved, thus proving to be a very effective remedy for clearing coughs. Its recommended daily dosage is 3-10g.

Conclusion

The Xiao chai hu tang is a Chinese herbal drug used for treatment of various symptoms and diseases. In the past, it was mainly applied in treating Shao yang symptoms but with time and improvement, it is now widely used to treat many diseases. It consists of seven basic herbs with chai hu being the main component in the composition and is used for exterior heat dispersion. The other six herbs are assistant drugs. Chai hu and Huang qin work together to produce a harmonizing effect in the interior and exterior of the body.

Before the xiao chai hu tang is administered, its mechanism has to be evaluated to ensure its pharmacological, toxicological and drug-interaction effects are in order. Clinical research has to be carried out too.

Xiao chai hu tang is administered depending on different conditions being exhibited by a patient. Majority of the time, one or two symptoms are displayed and someone has to keenly observe the symptoms so as to determine the kind of mixture and dosage to be administered.

A case analysis is done based on the various scenarios provided. From the analysis, we find that to be able to treat some symptoms, modification is done. This is by adding some ingredients and subtracting some from the decoction. Some ingredients when combined aid each other while others cause inhibition.

References

Altschuler, D., 2008. Wu wei zi: A great herb a little caution. Web.

Benskey, D & Gamble, A., 1993, Chinese Herbal Medicine Formulas and Strategies, Seattle Washington, Eastland Press Inc.

Can, E. & Cheng, M.Z., 2008. Harmonizing method in Shanghan Lun. The Journal of the Association of Traditional Chinese Medicine, 15(02).

Carter, B.B., 1999. Are my herbs and drugs dangerous together? . Pulse of Oriental Medicine.

Chen, J.K.& Chen, T.T., 2004.Ren Shen (Radix Ginseng). Chinese Medical Herbology and Pharmacology. Art of Medicine Press, Inc.

Chen, J., 2007a. Herbal monograph for Xiao chai hu tang, part two. Acupuncture Today, 08(07).

Chen, J. 2007b. Xiao chai hu tang (Minor Bupleurem Decoction) traditional use, pharmacological effects and clinical research.

Chinian, L. & Yubin, L.,1996. The clinical application of Xiao chai hu tang (Minor Bupleurum Decoction). Journal of Chinese Medicine,issue51

Hu, X.S., 2010. .

TCM Assistant, 2004. Mu li. E-Ms, inc. Web.

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