Nature: bitter, cold
Enters: Heart, Liver, Large Intestine, Stomach, Spleen
Actions: Clears heat; dries dampness; reduces fire; eliminates toxicity; clears heart fire, drains stomach and liver fire; adjusts the appetite; stops bleeding due to heat.
• Heart fire: irritability, insomnia, high fever, restlessness, coma, delirium. Also combined with Rou gui for heart/kidney disharmony.
• Stomach or large intestine damp-heat: diarrhea, dysentery, vomiting, acid regurgitation.
• Stomach fire: digestive dysfunction, belching with a putrid odor, excessive hunger and thirst, diabetes. Also with Wu zhu yu in Zuo Jin Wan.
• Heat in the blood: epistaxis, hematuria, hemafecia, hematemesis.
• Heat and toxicity: carbuncles, boils
• Topical: for red and painful eyes; ulcerations of the mouth and throat; first and second degree burns; exudative erythema multiforme. Often used as a powder or ointment.
• Cholagogue; lowers serum cholesterol in rats; anti-inflammatory.
• Sometimes thought of, among the three “Huang” herbs in this category, as the main herb for addressing the middle Jiao, though it actually treats all three.
• For heart heat, Huang lian treats the heart, its mother (wood-liver), and also its son (earth-stomach/spleen).
• Contains berberine (4.7%): a broad spectrum antibiotic and fungicide. More effective than sulfa drugs. As effective as synthetic antibiotics for bacillary dysentery, tuberculosis, scarlet fever, diphtheria.
• Canker sores.
• Ulcerative colitis.
• Vaginal trichomonas infection.
• Typhoid fever.
• Scarlet fever.
• Suppurative otitis media (administer in ear drops).
• Conjunctivitis, superficial keratitis.
• Anal fissures. (Applied repeatedly with cotton balls and increasing pressure.)
• Dry-fry it (Chao huang lian) to make it less cold and to help it enter the blood.
• Ginger-fry it (Jiang huang lian) to make it less cold, easier on the spleen and stomach, to treat stomach heat, help stomach Qi descend, and stop vomiting.
• Fry it with Wu zhu yu (Yu huang lian) to treat damp-heat in the Qi level, with such symptoms as diarrhea, vomiting, belching.
MLT: Combine Huang lian with any guiding herb to clear heat anywhere in the body.
• For diarrhea with stomach heat and an inability to ingest food, combine with Ren shen in a tea and sip throughout the day (it is alright if the patient vomits).
• With Huang bai, Huang qin, Da huang (4 yellows) for cancer.
PFGC: For heat in the upper Jiao: meningitis, cerebral hemorrhage, occasional dizziness, eye diseases with swelling and pain, canthus outcrop creeping over the eye (not for nebulous eye screen), bright red and rapidly spreading erisypelas.
• Damp-heat stagnating below the heart causing epigastric discomfort and fullness.
• Damp-heat: inflammations and ulcerations in the vagina.
• Contains the nutritive essence of fire and the functional nature of water – can resolve disorders that involve a chaotic interaction between fire and water: damp-heat in all three Jiaos.
• For eye disorders, coptis tea can be applied to the eyes with a cotton ball until the patient feels a bitter sensation in the throat.
• For red, swollen, painful eyes, coptis can be ground and mixed with sesame oil. The patient should then sniff its scent.
Hsu: Same antibiotic efficacy as sulfa drugs; stimulates gastric secretions (including from the pancreas); inhibits gastric ulcer formation; anti-inflammatory.
DY: Thickens the intestines, stops diarrhea; cools the blood; clears heat generated by dampness; treats vomiting and acid regurgitation caused by liver-stomach disharmony.
• The patient can take Huang lian with a slice of ginger on the tongue or eat ginger after taking it, if he or she is very sensitive to the bitterness. The herb can also be ginger-processed, wine-processed, or stir-fried until yellow to alleviate its bitterness.
• With Ban xia to harmonize upbearing and downbearing, Yin and Yang, to clear heat, dry dampness, transform phlegm, and stop vomiting. For indications such as nausea, vomiting, chest and epigastric fullness and distention, thick, yellow phlegm, yellow, slimy tongue fur, and a wiry, slippery pulse due to damp-heat, turbid phlegm, and/or mixed cold and heat causing stomach disharmony. Huang Lian Tang is typically used. For these indications, ginger-processed Ban xia and ginger mix-fried Huang lian should be used.
• With Gan jiang to eliminate cold accumulation and depressive heat, drain mixed cold and heat, in order to stop vomiting and diarrhea. The pair allows one to regulate upbearing and downbearing, to harmonize Yin and Yang, and to treat mixed cold and heat. The ratio of the two herbs can be adjusted (3-10g each) depending on whether heat or cold is predominant (use equal doses if heat and cold exist in equal proportion). For indications such as:
– 1. Vomiting, acid regurgitation, belching, epigastric pain or distention, and clamoring stomach (a feeling of hunger, burning, emptiness, unease, and sometimes pain in the stomach with nausea and acid regurgitation) due to a mixture of cold and heat in the stomach. (Ban Xia Xie Xin Tang) Use stir-fried Huang lian unless heat is severe.
– 2. Diarrhea, dysentery, and stomach rumbling due to mixed heat and cold and/or disharmony between the stomach and intestines. (Use stir-fried Huang lian unless heat is severe.)
– 3. Glossitis, stomatitis, and chronic, recalcitrant mouth ulcers due to spleen Yang deficiency and stomach fire.
• With E jiao to drain fire and enrich Yin according to the method of draining the south (i.e. fire) and supplementing the north (i.e. water), reestablish the interaction between the heart and kidneys, quiet the spirit, and treat dysentery damaging Yin. For indications such as:
– 1. Vexation, agitation, and insomnia due to febrile disease which has damaged Yin, deficiency fire, or heart and kidneys not communicating. (Huang Lian E Jiao Tang) Unprepared, or, even better, wine-processed Huang lian should be used.
– 2. Dysentery which damages Yin with pus and blood in the stools due to damp-heat in the large intestine.
– This is a key pair for heart-kidney disharmony, with symptoms mentioned above, plus many psychological disorders, loss of memory, profuse dreams, and tendency to wake up easily and frequently
• With Huang qin to effectively clear heat and dry dampness, drain fire, and resolve toxins from the upper, middle, and lower burners. For indications such as:
– 1. Red, swollen, painful eyes, toothache with red, swollen gums, oral ulcers, and glossitis due to full heat in the upper and middle burners. (Xie Xin Tang) Both herbs should be wine mix-fried. (The alcohol directs the action of these two herbs toward the upper burner.)
– 2. Vexation and agitation in warm disease with full heat or due to a breakdown in communication between the heart and kidneys. (Huang Lian Jie Du Tang or Huang Lian E Jiao Tang)
– 3. Diarrhea and dysentery due to damp-heat. (Shao Yao Tang)
– 4. Hematemesis and epistaxis due to heat in the blood. (Xie Xin Tang) Both herbs should be wine mix-fried.
• With Mu xiang to rectify the Qi, drain heat, dry dampness, and treat dysentery. This combination is used in Xiang Lian Wan for indications such as diarrhea, bloody and purulent dysentery, abdominal pain, and tenesmus due to damp-heat and Qi stagnation in the large intestine. Roasted Mu xiang should be used.
• With Rou gui (3-6g each) to harmonize Yin and Yang, drain the south (heart fire) and supplement the north (kidney Yang), and re-establish the interaction between the heart and kidneys. For indications such as:
– 1. Insomnia, vexation, and agitation due to heart and kidneys not communicating. (Such as for kidney Yang deficiency which cannot move and upbear kidney water, which then becomes dead and stagnant, and fails to nourish heart Yin and control heart fire which rises upward. Use Jiao Tai Wan.)
– 2. Glossitis, oral ulcers, heart palpitations, together with fear of cold, copious clear urination, impotence, and seminal emission due to simultaneous heart fire and kidney Yang deficiency.
• With Wu zhu yu to effectively drain liver fire, harmonize the stomach, downbear counterflow, and stop pain, acid regurgitation, and vomiting. For indications such as:
– 1. Lateral costal pain and distention, nausea, vomiting, acid regurgitation, belching, clamoring stomach, and a bitter taste in the mouth due to liver depression transforming into fire which disturbs the stomach. (Zuo Jin Wan – Huang lian:Wu zhu yu :: 6:1)
– 2. Diarrhea and dysentery due to damp-heat.
– The usual dosage for this pair is 3-10g Huang lian and 2-5g Wu zhu yu. Traditionally, the combination is for liver fire causing liver-stomach disharmony which, in turn, leads to nausea, vomiting, and acid regurgitation. In this case Huang lian should be prescribed in a larger quantity and Wu zhu yu in a lesser amount. However, this pair can also be used in patterns where cold and heat are mixed. In this case, if heat is predominant, the dosage of Huang lian should be proportionately more. If there is concomitant stomach Yin deficiency, add Shi hu. If cold is predominant, the dosage of Wu zhu yu should be proportionately more. If there is concomitant Qi deficiency, add Dang shen. If cold and heat are present in identical proportions, the quantities of both herbs should be equal.
• With Zi su (the leaves [Zi su ye] and stems [Zi su geng] of Perilla) to clear stomach heat, dry dampness, rectify the Qi, and stop vomiting. For the following indications, ginger mix-fried Huang lian should be used:
– 1. Vomiting and nausea due to stomach heat or damp-heat in the middle burner along with Qi stagnation in the middle burner.
– 2. Vomiting during pregnancy due to heat or damp-heat along with Qi stagnation in the middle burner.
• Huang lian is incompatible with pork or cold water.
• From Michael Moore (via internet): Goldthread (coptis), in my opinion, is possibly the queen of remedies for stomatitis and slowly healing mouth sores (Myrrh and Anemopsis being preferable for acute problems). If you ever get a chance to gather some, be sure to use the leaves and stems as well… all parts of the plant are active. The constant reference to Goldthread Roots is a clumsy remnant of the crude drug trade of a century ago… the dried roots could be stored in burlap bags for a DECADE, the foliage lasted but a year or two. With drastic loss of wild places in the last century, we need to revamp our often wasteful use of herbs, gathered according to standards set in greener (and profligate) times.
Huang Huang: Huang Lian Family Formula
A. Very bitter, and the taste lasts on the tongue, it will turn water yellow, and the tongue becomes yellow.
B. Western medicine has recently found that taking Huang Lian Su (an extract of Huang Lian) for a long time helps memory. In experiments it helps rats navigate mazes, and protects their brains (but not from scientists dissecting them).
C. This is superior class herbs, it protects the body, promotes life, good for long term use. D. Some think of it as antibiotic, but its function is to relieve irritability. Ex. Huang Lian E Jiao Tang for heart vexation and insomnia. In this formula one may use from 12-60g (depending on what original dosages really were.)
E . Vexation = insomnia and anxiety. [See power point picture.] One needn’t use He Huan Pi, Suan Zao Ren, etc., just use Huang Lian.
F. One commonly uses Huang Lian with warm or hot herbs. For diarrhea that is not foul swelling with Gan Jiang, for xin discomfort with Ban Xia, with Zi Su Ye as an infusion for xin discomfort in the throat.
II. Historical Information
A. Shen Nong Ben Cao Jing: Huang Lian: governs heat qi, eye pain,
eye injury, lacrimation, it improves the eyesight, also used for intestinal problems, abdominal pain, diarrhea, genital swelling and pain in women
B. Used in 12 formulas in SHL and 7 in JGYL
III. Patterns: Huang Lian treats heart vexation, epigastric focal distention, and diarrhea. The Huang Lian pattern are these three together.
A. Heart vexation (Pattern 1)
1. Largest dosage is 4 liang in Huang Lian E Jiao Tang, “Shaoyin disease for 2-3 days or more, heart vexation and insomnia.”
2. An ancient fable speaks of “groundless fears.”
B. Epigastric Focal Distention (Pattern 2)
1. Simplest formula is Da Huang Huang Lian Xie Xin Tang with just 2 ingredients
2. “Epigastric focal distention that is soft when pressed, pulse floating in the guan position.”(154)
3. With Xie Xin Tang, the xin may be uncomfortable, but not very painful when pressed and not hard. Often goes with stomach problems, if there are stomach problems one may develop insomnia and vs. versa.
C. Diarrhea (Pattern 3)
1. Ge Gen Qin Lian Tang “When in a greater yáng disease [the condition is a] Cinnamon Twig Decoction pattern, but the physician precipitates, [causing] incessant diarrhea and a pulse that is skipping, it means that the exterior has not resolved; when [there is] panting and sweating, Kudzu, Ge Gen Qin Lian Tang governs.” (37)
2. Bai Tou Weng Tang “When [there is] heat diarrhea with rectal heaviness” (371) and “When [there is] diarrhea with a desire to drink water, this means that [there is] heat; [therefore] Bai Tou Weng Tang governs.” (373)
3. There any formulas with this for diarrhea from the time of the Shang Han Lun and later.
IV. Huang Lian Constitution
A. Greasy face, irritability and heat, chest oppression and palpitations, epigastric focal distention, diarrhea
B. Huang Lian tongue
1. Tongue is firm and old looking, red or dull red, fur is yellow, slimy, and thick
2. Tongue body is old in appearance and lacks luster
3. If tongue is pale red, tender, and enlarged, with a thin white fur or no fur, must be cautious about using Huang Lian.
4. The tongue is important. This information comes from later physicians. A child’s tongue is soft and tender…this is the opposite. Huang Lian is not commonly used for kids, especially large dosages. Kids’s tongues are sensitive to bitter. (see power point pictures) Huang Lian is also for a completely red tongue with no coat (Huang Lian E Jiao Tang). The lower picture pairs it with Gan Jiang, the lower part of the tongue has some white, and it is not so hard. The upper picture is a Huang Lian Jie Du Tang picture, more yellow in the tongue, and it is harder.
C. Huang Lian pulse
1. Pulse should be slippery and rapid or rapid and skipping. Slippery, like pearls on a dish, but also a rapid pulse is usually slippery. A skipping pulse is faster than a slippery pulse. Patients usually have faster heart rates, and Huang Lian can control the heart rate.
2. if the pulse is slow and the body cool, use caution with Huang Lian.
N.B.: Hot body type tending toward damp heat and heart fire
V. Dosage of Huang Lian
A. Zhang Zhong-Jing typically had two ways of dosing Huang Lian
1. A large doses to eliminate irritability (4 liang)
2. A small doses to eliminate focal distention (1 liang)
B. Dr. Huang: large dosage is 10-15; low dosage is 2-3g. A large dosage can cause stomach discomfort. Quite often he combines with Fu Zi, Gan Jiang, or Rou Gui. If he combines two formulas he uses dosage in middle range.
C. His colleague Tong Xiao Ling uses 30-60g. Treats diabetes without Western medicine.
D. Others use large amounts for fever in short term.
N.B.: If a patient needs Huang Lian the taste not bad, it is refreshing. It starts to taste bitter as they improve. One can often see the reaction of patient to herbs, if they like them or not, feel better or not.
VI. Huang Lian Formula Family
A. Huang Lian Tang
B. Xiao Xian Xiong Tang
C. Huang Lian E Jiao Tang
D. Huang Lian Jie Du Tang
E. Ge Gen Qin Lian Tang
F. Ban Xia Xie Xin Tang
Huang Lian Tang
I. Traditional Dosage
Huang Lian 3 liang
Gan Cao 3 liang
Gan Jiang 3 liang
Gui Zhi 3 liang
Ren Shen 2 liang
Ban Xia 1/2 sheng
Da Zao12 pc.
Cook herbs in 2000 ml down to 1200 ml. Take warm, three times in the day and twice in the night.
N.B.: Low dose, taken frequently. Original instructions are to take 3 doses during the day and 2 at night. May have been considering that the patient had nausea and vomiting, making large herb dosage more difficult.
II. Classical Presentation
A. When in cold damage, [there is] heat in the chest, evil qi in the stomach, pain in the abdomen, and a desire to vomit, Huang Lian Tang governs.(173)
B. Heat in the chest=chest oppression and irritability, palpitations, insomnia
C. Evil qi in the stomach=abdominal discomfort, abdominal pain, nausea and vomiting, intestinal rumbling
D. Hu Xi-Shu thought there was water qi in the stomach
E. Key indicators: Abdominal pain and desire to vomit:
F. Abdominal pain usually periumbilical and paroxysmal or stuffed feeling: this is a key indicator for use of Gui Zhi
E. Usually accompanied by diarrhea
III. Dr. Huang’s Dosages
Huang Lian 10g.
Gui Zhi 15g or
Rou Gui 10g
Dang Shen 10g.
Ban Xia 15g.
Gan Jiang 10g.
Da Zao 20g.
Dr. Huang’s dosage is in the middle range because there are both fan zao and digestion problems. Administration: need to take 5 times/day, 3 in day, and 2 at night, maybe because of the acute nature of the disease. Use either Gui Zhi or Rou Gui or both together. With Rou Gui one should use a lower dose. Using Rou Gui as a substitute for Gui Zhi has benefits: Rou Gui better able to relieve pain, warm the stomach, and settle palpitations. Dr. Xie comments: patient also has pain below umbilicus from intestines. Blood vessels contracted there?
A. Thin body
B. Dull pale tongue with thick white fur
C. Distinct digestive system symptoms, such as abdominal pain, nausea and vomiting, diarrhea, etc.
D. Generally accompanied by irritability, palpitations, insomnia
E. Dark complexion, tongue dark, dull, washed out
F. According to Xia Yi-Jun (Jiang Su), when using this formula, the tongue fur may be thick and white, especially on the back half of the tongue
V. Suitable Diseases
A. Gastric paresis secondary to diabetes
1. Common autonomic nervous system symptom associated with diabetes
2. Commonly manifests as chronic gastritis, poor stomach tone with food retention
3. Abdominal distention, easily full, poor appetite, belching, nausea, vomiting, weight loss, all worse after meals
4. Abdominal exam: distention and fullness and water sound
5. Reduced peristalsis, stomach dilation, delayed emptying, pylorus too open
6. Gastroscope: hyperemia of stomach mucosa, edema, erosion
7. For “things stuck in stomach,” it is particularly good for this.
8. Huang Lian and Rou Gui both decrease blood sugar, these two constitute the formula Jiao Tai Wan that quiets the spirit.
B. Food damage
1. On Dr. Huang’s website, report of a physician cooked Huang Lian Tang and sold it in the springtime as a “Western med” for gastritis
2. For people who eat irregularly, eat and drink large amounts suddenly
3. For children who overeat sweets and fatty rich foods, causing blockage with abdominal pain, diarrhea, nausea, vomiting (acute gastronenteritis)
4. Used original formula without any additions and without Western meds
5. Worked very well and sold like crazy!
1. After getting drunk, can alleviate vomiting, diarrhea , dizziness
2. Clears the mind and GI distress, also clears bad breath.
3. Dr. Huang adds Ge Gen that overcomes alcohol poisoning and can clear mind. After drinking people get stiff neck, bent over, swollen tongue.
4. Flushing up of yang after drinking a little is a Huang Lian and Rou Gui problem, one can use it as a prophylactic.
D. Chronic gastritis, stomach ulcers
1. Commonly seen in thin patients with dark complexion and a tendency to diarrhea
2. Must have signs of heat in tongue or face, irritability and insomnia. Common and chronic in middle age men. Their complexion gets bad, tongue fur thick and slimy. This is especially seen in smoking men.
3. In clinic cold and hot are commonly mixed, especially in digestion disorders. One can use harmonizing formulas as well as San Huang Xie Xin Tang together with Si Ni Tang, etc.
E. Myocarditis, Tachycardia
1. This formula can bring the heart rate down.
F. Fevers in stomach-intestinal colds
Case History: Recurrent fevers
Dr. Huang observed Xia Yi-Jun treat a patient with recurrent fevers. After the fever, he would sweat and then get cold. Stool was unformed, root of the tongue had a thick white fur. Treated effectively with this formula
Case History: Intractable fevers
A man had fevers that would not go away after a stomach infection. He had this type of constitutional tongue. One must treat this type with Huang Lian and Rou Gui.
N.B.: One commonly uses Huang Lian with warm or hot herbs. So it is for this presentation. Also for diarrhea not foul swelling with Gan Jiang, for xin discomfort with Ban Xia. With Zi Su Ye as infusion for xin discomfort in throat.
G. Insomnia, Neurosis
1. Accompanied by diabetes or stomach pain and distention
2. Can use original formula
3. Can also use equal parts of Huang Lian and Rou Gui as an infusion before bed (2-3 mouthfuls can aid sleep)
VI. Compared with Xiao Chai Hu Tang
A. Xiao Chai Hu Tang for fevers, Huang Lian Tang for abdominal pain
B. Both formulas treat nausea and vomiting
C. Xiao Chai Hu Tang accompanied by fever, and fullness and discomfort in the chest and rib side area
D. Huang Lian Tang accompanied by lower abdominal pain, diarrhea, palpitations, irritability. It can bring down fevers.
E. Difference is upper and lower, inner and outer
VII. Compared with Ban Xia Xie Xin Tang treats
A. Ban Xia Xie Xin Tang epigastric focal distention
B. Huang Lian Tang treats abdominal pain with intestinal rumbling and diarrhea
C. Both treat disorders of the digestive system. The difference lies in stomach vs. intestines
D. Huang Lian in combination with Huang Qin was important to Zhang for epigastric distention.
Xiao Xian Xiong Tang
I. Traditional Dosage
Huang Lian 1 liang
Ban Xia 1/2 shen
Gua Lou Shi 1 large piece.
First cook Gua Lou in 6 sheng of water down to3 sheng. Add other herbs and cook down to 2 sheng. Take warm in 3 doses.
II. Classical Pattern
A. When in minor chest bind disease, [the location is] directly below the heart and painful when pressure is applied, and the pulse is floating and slippery, Xiao Xian Xiong Tang governs.(138)
B. Chest bind is ancient term from the Shang Han Lun.
1. Refers to evil qi bound in the chest.
2. Chest pain with hardness and fullness in the local area
3. Major and minor are differentiated on the basis of symptom severity
4. Minor: water and heat bound in the epigastrium, painful when pressed; floating slippery pulse
5. Major: excess heat bound from epigastrium down to lower abdomen, area is hard and full and cannot be touched; deep pulse
C. Epigastric is painful as well as uncomfortable, pulse slippery and rapid
III. Dr. Huang’s Dosages
Huang Lian 5g
Ban Xia 15g
Gua Lou Shi 30g
Rare to use without other herbs, Dr. Huang combines it with Xiao Chai Hu Tang (called Chai Xian Tang), or with Da Chai Hu Tang, he calls it (Xiao Xian Tang??)
A. Red face with oily luster
B. Rib-sides and upper abdomen resist pressure and may be painful
C. Cough, sticky yellow phlegm
E. Red tongue with yellow slimy fur
F. Floating slippery pulse, may be flooding
G. Lots of sputum…important symptom. The type that “will stay on street for three days.” Constipation important
V. Suitable Diseases
A. Chest oppression, cough and wheezing
1. Bronchitis, asthma, bronchiectasis, pneumothorax
2. All with chest oppression and sticky yellow phlegm
3. Important: pain with lots of sticky yellow sputum. After a cold, it’s often like this. Dr. Huang combines it with Xiao Chai Hu Tang
4. Also for bronchial asthma, combine with Da Chai Hu Tang if there is constipation. Once it unblocks the bowels, sputum will decrease.
B. Chest pain
1. Hypertension, cardiac disease
2. Oily red complexion
3. Chest oppression
5. Cough with copious phlegm
6. Corornary heat disease:, forgetful, SOB, often worry about BM and often constipated. May also have cough. Some use this for angina. Some use this instead of Dan Shen, Hong Hua, etc. This similar to chest bi formulas.
C. Abdominal pain
1. Gastritis, cholecystitis, pancreatitis, biliary reflux gastritis, acute and chronic gastritis,
2. With symptoms of upper abdominal fullness, oppression, and pain with pressure
3. Accompanied by nausea, vomiting, and constipation
4. One can combine it with Da Chai Hu Tang for chronic constipation.
A. Clears heat, transforms phlegm, unblocks stool
1. Commonly used for respiratory infections
2. Chest oppression and pain with sticky yellow phlegm
4. After taking this formula, stool should move, phlegm reduce, and chest discomfort alleviate
5. So for respiratory infections. Main thing, chest pain, productive cough, constipation.
Should decrease intake of meat and alcohol, eat turnips, clear and unblock bowels.
B. Purges Mucous
1. After taking formula, some patients discharge mucous, thought to be phlegm and not a problem
2. For example, there was a middle-aged guy with asthma, with Da Chai Hu Tang, after diarrhea with mucus, felt much better. He felt good after taking it.
3. What’s connection of mucus in stool from lung? May be Lung/Large Intestine connection. One should ask patients about this. Note that sometimes blood stasis comes out with the stool.
4. Example: Used for toxic exposure, had sticky stuff in stools, and felt much better.
Case History: Phlegm
Liu Duzhou treated Ms. Sun (58) for stomach duct pain, worse with pressure, pain site was swollen like an egg buts oft, she was afraid of cancer but imaging ruled it out. Pulse wiry, slippery, and forceful; white slippery tongue fur; appetite, bowels, urination all normal
Huang Lian 9,
Quan Gua Lou 30,
Ban Xia 10
Took 3 packs, discharged a large amount of yellow, sticky fluid in the stool and symptoms resolved
VII. Formula Combinations
A. Severe chest and rib-side pain: combine with Si Ni San
B. Bitter taste in the mouth and alternating chills and fever, combine with Xiao Chai Hu Tang [This is called Chai Xian Tang]
C. For herpes zoster, post herpatic neuralgia, fibrocystic breast disease. Use Chai Xian Tang. These are often seen with alternating chills and fever, bronchitis, cholecystitis.
D. Fullness and pain in upper abdomen, combine with Da Chai Hu Tang. Da Chai Hu Tang treats a very tender chest, bronchitis, Gall Bladder. Why use Huang Lian if there is a lot of pain in the xin? Huang Lian is not the focus, but it is not contraindicated, just not indicated.
VIII. Compared with Da Xian Xiong Tang
A. Da Xian Xiong Tang treats whole abdomen, which is hard, full, and painful so it cannot be touched, stone-like hardness
B. Xiao Xian Xiong Tang just for epigastric region that is only painful when pressed
C. Both treat pain
D. Da Xian Xiong Tang is not commonly used, Da Chai Hu Tang is used much more often.
VIII. Compared with Da Chai Hu Tang
A Da Chai Hu Tang governs digestive tract counterflow,
B. Xiao Xian Xiong Tang governs respiratory tract infections
C. Both treat epigastric pain, vomiting, and constipation
D. Da Chai Hu Tang: epigastric fullness and pain, distinct abdominal fullness,
E. Xiao Xian Xiong Tang: chest oppression and pain primary, epigastric area only painful with pressure
F. For Da Chai Hu Tang hurts, XXXT xin is only tender on palpation.
Huang Lian E Jiao Tang
I. Traditional Dosages
Huang Lian 4 liang
Huang Qin 2 liang
Shao Yao 2 liang
Ji Zi Huang 2 yolks
E Jiao 3 liang
1200ml of water with 1st 3 herbs, cook down to 400ml, remove dregs and add E Jiao. Cool, then add egg yolks. Take warm in 3 doses.
II. Classical pattern
A. “When in lesser yin disease [that has lasted] more than two or three days, [there is] vexation in the heart and inability to sleep, Huang Lian E Jiao Tang governs.” (303)
B. Patient is irritable and restless, tossing and turning
C. Insomnia, irritability trying to get to sleep that is slightly better during the day
D. Difficulty focusing attention, poor memory
E. Chest oppression and palpitations
F. Fan zao and can’t sleep, too irritable to even lie down.
G. Poor memory. Poor memory is not only a kidney problem, may use this.
N.B.: Dr. Huang believes the original lines leave out some things: there should be bleeding in stool, other places. This theory is based on ingredients, both Bai Shao and E Jiao stop bleeding. This is the type of bleeding one gets with dysentery and other infections that also have epigastric distension. Bai Shao indicates there can be severe abdominal. Huang Lian has the biggest dosage, mostly for mental irritability. People will feel hot, but won’t be hot, this is “fan” or “anxiety.”
III. Additional indications
A. Epigastric focal distention
B. Abdominal pain
C. Chronic dysentery with pus and blood
D. Blood in the stool
E. Flooding and spotting (menstrual)
F. Red crimson tongue
IV. Huang Lian and Huang Qin
A. Epigastric focal distention and abdominal pain
B. Heat in the upper abdomen, indeterminate gnawing sensation, abdominal pain, tenesmus, pus and blood in the stool or fresh blood in the stool
V. Huang Qin, Huang Lian, and E Jiao
Huang Lian and E Jiao are used together to treat xue zheng (bleeding). Note the use of E Jiao in Huang Tu Tang. Huang Lian and E Jiao are used to treat dysentery, one repeatedly sees this in the Qian Jin and Wai Tai; for example in Zhu Che Wan. Tao Hong Jing’s Fu Xing Jue Zang Fu Yong Yao Ban Fa has “Xiao Zhu Niao Tang” used for “heaven-current fever,” insufficient heart strength, fire heat arising internally, fidgetiness sitting or lying. At present it is good for pure blood as in chicken or duck liver formulas. Its formulas, dosage, boiling method, are the same as Huang Lian E Jiao Tang in the Shang Han Lun.
VI. Modern Dosage
Huang Lian 5-10g
Huang Qin 10g
Bai Shao 15-30g
E Jiao 15g
Ji Dan Huang 2
Original way is to cook twice, add one egg yolk to each.
A. Medium build, white skin, ruddy complexion, skin was moist but now coarse;
red lips, tongue, and eyes, firm flesh
B. Irritable, insomnia, copious dreams, generalized heat, palpitations, tachycardia,
epigastric focal distention
C. Easily develop purpura, nosebleed, blood in stool
D. Early menses, mid-cycle bleeding, fresh red blood, sticky blood
1. Tongue body is red like a strawberry, may have erosion or ulcers or cracks
2. Surface dry and lacking fluid
3. Mirror tongue, peeled tongue
4. Tongue body hard
5. The tongue is the most important sign, very red, like strawberry. Commonly it will hurt, or ulcers, or cracks. Power point has a typical picture of the tongue, leathery maybe old, cured beef looking. The opposite type of tongue counterindicates this formula.
F. Good looking, red lips are important. Firm flesh, the opposite of the Huang Qi constitution. Often have different kinds of bleeding, thus the use of Bai Shao and E Jiao, and Huang Lian also stops bleeding. Should have profuse periods, gushing feeling, what is scanty? Asking about pads is not precise, more important is the feeling, gushing or smooth, if it is otherwise it is scanty. Some women will have scanty but very viscus and bright red.
VII. Typical Uses
A. Irritability and insomnia following a febrile disease
1. After febrile disease there is often malnourishment, maybe that is why is egg yolks are needed.
Case History: Insomnia following a febrile disease
15 male, fever of 11 days, red face, red lips, red tongue, yellow coat, insomnia, sunken thin rapid pulse. Tried lots of formulas, then just combos of herbs. Dr. Huang used Huang Lian E Jiao Tang at these dosages. After the 1st dose he was much better. Dr. Huang followed up with Sheng Mai San with additions.
B. Anxiety and depression
C. Hemafecia after bacterial dysentery or typhus
Case History: (see power point, this was not translated.)
The hemafecia was accompanied by severe insomnia and irritability.
D. Thrombocytopenic purpura
1. Usually add Sheng Di Huang. Sheng Di is a stop-bleeding herb, not a bu yin herb. Xi Jiao Di Huang Tang is meant to stop bleeding. Zhi Gan Cao Tang has a large dosage, so he thinks to stop bleeding. Therefore Sheng Di and E Jiao treats uterine bleeding, also subcutaneous bleeding.
2. If stool is dry and constipated, add Da Huang. If one adds Da Huang this forms San Huang Xie Xin Tang. In the Jin Kui Yao Lüe, if one spits blood or has nose bleeds, Xie Xin Tang masters it.
Case History: Liver Disease
This was a 58 year-old women (see power point picture) with liver disease, splenomegala, blood platelets down. Bleeding from gums, everything red including tongue, stool not soft, purple macules in lower body, sleep was OK, menses vaguely normal. Face is greasy.
Dr. Huang used this formula.
Huang Lian 6
Huang Qin 12
Zhi Da Huang 6
Sheng Di 30
E Jiao 15
Bai Shao 30
One month later, she was better, smooth stools, platelets increased, proteins better. He then upped the Bai Shao to 60
E. Uterine bleeding
1. Menorrhagia, mid-cycle bleeding, early menses, bleeding with IUD, adolescent uterine bleeding, threatened miscarriage
2. Small amount of fresh red, thick blood
3. Can add Sheng Di Huang, Chi Shao, Mu Dan Pi
Case History: Irregular bleeding
This was a 48-year-old woman with diabetes for 10 years. Bleeding irregular, doesn’t stop, M.D.s wanted her to get D&C, she didn’t want one so she came to Dr. Huang. She couldn’t sleep, had discomfort in abdomen. Dry mouth, bitter taste, pain if pressed on her focal distension. After 2 packages the bleeding stopped. She took this regularly and blood sugar returned to normal. (She never took western meds for it.) Because the Huang Lian didn’t taste bitter to her he upped the dose. She called recently with back pain and he gave her a formula by phone.
F. Recurrent mouth ulcers, oral lichen planus
Case History: Mouth sores
This is a study of Cheng Feng Shi, from the “Journal of Dental Prevention andTreatment;2001. 03” He used Huang Lian E Jiao Tang with Zhu Ling Tang very effectively. Zhu Ling Tang also has E Jiao. Cheng generally used Gan Cao Xie Xin Tang. One may combine these.
G. Loss of voice from cerebral infarction
Case History: Aphasia
(1998) Woman, 80, had aphasia after stroke. She was aware but couldn’t speak. Restless, irritable, couldn’t sleep. Also had a very red tongue without coat. Added Sheng Di, Mai Men Dong and Gan Cao. Appetite also came back. Finally speech started coming back. Maybe for Alzheimer’s, stroke, etc. Need key symptoms, irritability, thin, insomnia, red tongue. Egg yolks for brain
1. Accompanied by irritability and dry mouth
I. Dry red skin
1. Used in Japan. Skin must be dry and red, but not itchy. May have bleeding from scratching. Worse with exposure to sun. E Jiao good for women’s skin or use pig’s feet. Pork, especially pork skin, like ham hocks, is good for skin. Vegetables are also good. Chicken feet also good for skin. Might be used for rosacea.
1. Formula is not for long-term use
There is a large dose of Huang Lian so decoction is very bitter, not used long-term, just until symptoms are alleviated. Huang Lian will dry up skin if used too long. It will also damage the appetite. At least cut back on dosage.
2. Don’t use herbs just from the tongue picture
Many elderly people have a mirror tongue or cracked tongue, tongue crack may be congenital, many children have a geographic tongue that may be genetic, if these people do not have any problems, no need to use the formula. One needs to see fan zao, insomnia, etc. Lots of elderly have no tongue coating.
K. Common modifications
1. Bleeding: add Sheng Di Huang
2. Abdominal pain that refuses pressure: add Zhi Da Huang
3. Lower abdominal pain: add Mu Dan Pi
L. Special method for decocting E Jiao
1. E Jiao should be melted into the formula or dissolved before adding it
2. Can be pulverized and then dissolved with small amount of water or wine
3. Place in a steamer or double-boiler until dissolved, then add small amount of sugar
4. Add dissolved solution to decoction
5. Now we have powder, one can use that it is much easier.
Huang Lian Jie Du Tang
I. Traditional Dosage
Huang Lian 3 liang
Huang Qin 2 liang
Huang Bai 2 liang
Shan Zhi Zi 14 pieces
Take these four ingredients, cut up and add to 6 sheng of water, cook until 2
sheng are left and take in divided doses.
II. Original Indications
A. Intense Great Heat (? ? huo zheng)
1. This refers to fever with a prolonged high temperature or to someone with a normal
temperature that is very averse to heat, has hot soles and palms, and a red face.
B. Irritability, vomiting, groaning, odd speech, unable to sleep
1. Should have clear psychoemotional symptoms with irritability, restlessness, emotional upset, insomnia, etc. But these might be hard to elicit from patient.
2. Mild versions have decreased memory, difficulty in focusing, lightheadedness, and headache.
C. Dry Mouth
1. Tongue and mouth dry with a yellow or burnt looking tongue coating and a tongue body that is usually red with prickles.
2. One can observe this, tongue like desert, lots of prickles.
III. Typical Dosages
Huang Lian 15g
Huang Qin 10g
Huang Bai 10g
Shan Zhi Zi 15g
As a decoction.
D. Indication #1 – Acute phase of infections diseases
1. Epidemic meningitis, type B encephalitis, leptospirosis, septicemia with fever,
irritability and restlessness, and insomnia or lethargy
2. Used by both shang han and wen bing specialists. See power point. This was used by
the Jin Yuan “Four Big Schools’” Liu Wan Su directly for fevers from wai gan. Also used in Qing Dynasty with cool blood level formulas.
3. Given to chickens for aviary typhoid. Put it on feet. For ducks with hemorrhagic septicemia. If won’t eat, they force feed it.
E. Indication #2 – Acute Infectious Diseases
1. Examples include acute hepatitis, acute gastroenteritis, bacterial dysentery, urinary
tract infections, and pustular skin diseases.
2. Besides epidemic diseases it is for any dangerous disease because of its strong antimicrobial effect.
G. Indication #3 Erythmatous skin diseases
1. Erythema nodosum
2. This is a kind of auto immune disease with big blotches that are tender on the lower legs, vaculitis.
H. Indication #4 – Red, Swollen, Painful Joints
1. Rheumatoid arthritis, septic arthritis, gout
2. Can combine with ma Huang Fu Zi Xi Xin Tang Sometimes add Xiao Chai Hu Tang.
This is common combo, anti-inflammatory
I. Indication #5 Cerebrovascular Disease
1. Hypertension, cerebral infarct, cerebral hemorrhage, Alzheimer’s disease
2. Huang Lian helps memory. A well-done study in Japan used when there was anxiety, insomnia, etc.
3. Old people get very restless, just pace back and forth, rip things up, may yell, their tongues are all red.
J. Indication #6 Disease of the Oral Mucosa
1. Lichen planis oral mucosa completely red and painful, hard to eat.
2. Will help in a couple of days. Needs large amount of Gan Cao; don’t use too long.
K. Indication # 7 Sjorens syndrome
Case History: Sjorens syndrome
Sjorens syndrome, thrombocyto purpura. Platelets were very low when she come. MDs took out spleen, but RBC kept going down, gave her transfusions of platelets. Didn’t work.
Huang Lian 6
Huang Qin 6
E Jiao 20
Bai Shao 30
Sheng Di 40
Zhi Da Huang 30
Things rose very quickly. Huang Qin was used to stop bleeding, Dr. Huang increased the dosage
I. Indication # 8 Steroid therapy sequelae
1. Swollen, red, increased appetite, irritable.
J. Indication # 9. GYN pelvic inflammatory disease
1. dysmenorrhea, leucorrhoea, lots of clots
2. These women are usually buff, in their 30s
K. Indication #10. cervical erosion
1. As an external application
1. This formula is very bitter, but the right constitution won’t mind.
2. Robust, pretty red in face.
3. Huang Lian E Jiao Tang types have fair skin, but Huang Lian Jie Du Tang types like drink too much, they have a greasy face, congestion of eyes, excretions from eyes, and a Huang Lian pulse.
4. Abdomen tone is OK, but uncomfortable upon palpation.
5. Emotional labile
6. Easily infected.
7. Women have leucorrhoea: profuse, yellowish-red
8. Can have athlete’s foot, pustular foot problems
9. Lab findings: HBP, increased ht rate, higher than normal hemoglobin and RBC.
1. Because main herbs lower BP lower RBC etc. don’t give to anemic people
2. The person must be appropriate. Must have good appetite, if they already have bad appetitive, one must lower dosage. If they are strong, buff, don’t worry.
3. Huang Lian Jie Du Tang can affect liver function. After a couple months one must check the liver. Huang Qin is the cause. If there is bleeding, use high dosages of Huang Qin, if they don’t, lower the dose.
N. How to Take
1. Even granules can be difficult to take, in Japan they put it in apple or pear juice.
2. As decoction, take some sweets. Bensky says, coat mouth with honey, then gulp it down. Patients can figure this out. Can try to first brush teeth with toothpaste.
3. Must not too warm so they can swallow it quickly.
Dose: 1.5-9g (0.5g promotes digestion and improves the appetite)
SD on Berberine:
Berberine is an isoquinoline alkaloid with a bright yellow color that is easily seen in most of the herb materials that contain any significant amount of this compound. Among Chinese herbs, the primary sources are phellodendron and coptis (similar isoquinoline alkaloids, in these herbs, such as jateorrhizine, coptisine, palmatine, and columbamine, also have a yellowish color). Berberine has long been used as a dye; it is currently known as “natural yellow 18,” being one of about 35 yellow dyes from natural sources.
Coptis chinensis rhizomes (huanglian; literally “yellow thread”) and related species used as its substitutes have about 4-8% berberine, while Phellodendron amurense bark (huangbo, literally “yellow bo,” where bo is this particular type of tree) has about half as much, at 2-4% berberine. This compound is also found in the less commonly used Chinese herb sankezhen (B. sargentiana) and in the Japanese barberry (woody portion of Berberis thunbergii). All of these herbs are known as therapies for damp-heat syndromes, particularly for intestinal and lung infections, and they are used topically for various skin diseases. Several Western herbs also contain berberine, such as barberry root bark (Berberis vulgaris), Oregon grape root (Berberis aquifolium), and goldenseal root (Hydrastis canadensis). Berberine was isolated and used as an herbal drug in China 50 years ago (the drug forms are usually the hydrochloride or sulfate; the chloride, as used in the dye, may have the strongest antiseptic action). It has since become an ingredient in several Western herbal products, particularly for treatment of intestinal infections.
Coptis and phellodendron have been used in China for treating gastrointestinal diseases with reported success; applications have included acute gastroenteritis, cholera, and bacillary dysentery. So, the first applications of isolated berberine were for treatment of these conditions. Recent clinical trials have yielded conflicting results as to which of the disease organisms causing intestinal symptoms are responsive to berberine (1, 2). Tests of the antiseptic action of berberine against bacteria, yeasts, viruses, and amoebas have shown a range of activity levels from apparent potent action to mild suppression. Inhibition of giardia and of candida have been areas of considerable interest and initial positive research results have led to development of several herb products for those applications.
Soon after berberine was prepared as an isolated agent for clinical use, it was noted that berberine had other potential benefits; for example, it appeared to reduce high blood pressure at doses of about 1 gram per day (3). The hypotensive action of berberine has been confirmed in several pharmacology experiments, but follow-up clinical trials have been lacking. Still, this effect of berberine fortunately led to further testing of the compound for patients with cardiovascular disease risk factors, and evidence developed to demonstrate a lowering of cholesterol (and triglycerides) and of blood sugar. These new findings are the main focus of this brief report.
There has been increased interest in lowering blood cholesterol, and especially LDL-cholesterol, as a means of curtailing the high rates of heart attack and stroke. In addition to recommended dietary changes, many people are prescribed statin drugs for this goal. The statin drugs are powerful, frequently effective, and may have other benefits, though they also pose certain risks. During the 1990s, the Chinese herb material “red rice yeast” (Monascus purpureus) was sold in the U.S. as a natural supplement that contains, as one of its active ingredients, small amounts of lovastatin, one of the widely used statin drugs (it also contains several related compounds that contributed to the cholesterol lowering action). After prolonged legal disputes between the supplement providers, the drug companies, and the FDA about its content of the drug substance, the sale of red rice yeast and its extracts as natural cholesterol lowering agents was banned.
It was reported recently that berberine lowers cholesterol through a mechanism different than that of the statin drugs, suggesting potential use both as an alternative to the statins and as a complementary therapy that might be used with statins in an attempt to gain better control over cholesterol. In a controlled Chinese study (4), it was shown that berberine, administered 500 mg twice per day for 3 months, reduced serum cholesterol by 29%, triglycerides by 35% and LDL-cholesterol by 25%. The apparent mechanism is increasing the production of a receptor protein in the liver that binds the LDL-cholesterol, preparing it for elimination.
Research on use of berberine for diabetes began with Ni Yanxi and his colleagues in Changchun (a large city in Jilin Province) with diabetes treatments. As an introduction to a 1995 English language publication on this subject (presenting their earlier clinical data from 1983-1987), they wrote (5): “It was found by accident that berberine had the therapeutic effect on the decrease of blood glucose when the authors used berberine to treat diarrhea in patients who suffered from diabetes.”
Dietary therapy was first introduced to the patients for one month. For those who still had high fasting blood sugar, berberine was administered orally at a dose of 300, 400, or 500 mg each time, three times daily, adjusting the dosage according to the blood glucose levels; this treatment was followed for 1-3 months. A control group without diabetes was similarly treated, with no effect on blood sugar. For the diabetic patients, it was reported that patients had less thirst, consumed less water and urinated less, had improved strength, and had lower blood pressure; the symptoms declined in correspondence with declining blood glucose levels. Laboratory studies suggest that berberine may have at least two functions in relation to reducing blood sugar: inhibiting absorption of sugars from the intestine and enhancing production of insulin. As relayed by Ni in his review of the literature, clinical experience with berberine has shown that doses of 2 grams per day produced no side effects.