[Chinese Medicine] learning experience (38) Banxia Xiexin Decoction

The notes I compiled are based on the textbook "Prescriptions" of the University of Traditional Chinese Medicine, and some prescriptions that I think are good. The prescriptions written are all my personal experience, and the analysis methods are mainly based on the six meridians and the viscera. I am not a medical professional, studying medicine is purely a hobby. It is normal if there are mistakes in the text.

(38) Pinellia Xiexin Soup

[Source] "Treatise on Febrile Diseases"

【Category】Reconcile cold and heat agent

[Ingredients] Pinellia washed, half a liter (12g), 3 liang each of skullcap, dried ginger, and ginseng (9g each), 1 liang of Coptis chinensis (3g), jujube broken, 12 pieces (4 pieces), licorice broiled, 3 liang (9g)

[Usage] For the seven flavors, boil six liters with one bucket of water, remove the water, and fry again, take three liters, take one liter warm, and take three times a day (modern usage: decoct in water).

[Indications] To regulate cold and heat, dissipate stagnation and eliminate swelling.

The pathogenesis of the indications of this prescription is very complicated, with mixed cold and heat, as well as the combination of deficiency and excess, resulting in disharmony of the middle burner and abnormal elevation, but mainly damp and heat inward. The formula can be regarded as Xiaochaihu soup without Bupleurum, adding Coptis chinensis, and replacing ginger with dried ginger.

Banxia Xiexin Decoction only has article 149 in Treatise on Febrile Diseases: If you have typhoid fever for five or six days and vomit and develop fever, you will have the symptoms of Chaihu Decoction. Although this has been done, it is not against it, it must be steamed and vibrated, but it will be relieved by sweating. If the heart is full and painful, it is a knot in the chest, and Daxianxiong Decoction is the main treatment; but if it is full but not painful, it is a lump, and Bupleurum is not suitable for it, and Banxia Xiexin Decoction is suitable.

This article can be divided into two paragraphs. From "five or six days of typhoid fever" to "relieved from fever and sweating" is the first paragraph, and the rest is the second paragraph.

First explain the second paragraph, which follows the previous one (Article 148). The previous article talked about "the heart is full", and the identification is carried out here. If the heart is full and hard, it is a chest disease caused by water and heat intertwined, and Daxianxiong Decoction is suitable. Fullness but no pain is a syndrome of ruffian. "Ruffian" comes from "Book of Changes · No", the upper hexagram is Qian, the lower hexagram is Kun, and the hexagram image is blocked up and down, which is a fierce hexagram. Lumpy syndrome is a disease in which the upper and lower sides are obstructed. The pathogenesis is the loss of spleen movement and the internal generation of turbid yin (dampness evil), which makes the qi stagnate in the middle burner (stagnant heat).

Let's talk about the first paragraph, I don't know where it was scattered and inserted here. Here we also explain: Shaoyang disease can be vomiting or not. If it is simple vomiting, it is the syndrome of Xiaobanxia Decoction. If it is vomiting and headache, it is the syndrome of Evodia decoction. Only vomiting and fever is the definite Shaoyang disease.

The patient is Shaoyang disease, it is suitable to use harmony method, not to conquer. Although the doctor used the method, the patient's symptoms of Shaoyang disease still persisted, indicating that the evil had not completely entered the inside, and Xiao Chaihu Decoction could still be used. But because the attack hurts part of the righteousness, the patient will tremble and then sweat out, which is actually a dizzy reaction.

Next, let’s talk about the principle of swelling. Among the five viscera and six fu organs, the kidney, spleen, and liver are in charge of ascending, while the lungs, gallbladder, and stomach are in charge of descending. Among them, the spleen and stomach are located in the middle palace, and they are the pivots for ascending and descending. If the ascending and descending of the spleen and stomach is abnormal, the overall Qi movement will be abnormal. The syndrome of Banxia Xiexin Decoction refers to the disorder of spleen and stomach ascending and descending. Clear yang cannot rise, turbid yin cannot descend, or stagnates in the triple burner, or stagnates in the original membrane, or stagnates in the interlayer of the epigastric cavity. This is the syndrome of swelling. The mechanism of ruffian and fullness is slightly the same but the parts are different. Distension is in the abdomen, but swelling is under the heart; distension is visible, but distension is invisible; distension is a subjective symptom that feels like something is blocking the epigastric cavity, but when you press it with your hands, it feels moist but not hard. There are many reasons for the abnormal ascending and descending of the spleen and stomach, and the syndrome of Banxia Xiexin Decoction is caused by damp-heat resistance.

I personally have a general description of this certificate:

Blocking evil qi, like squatting in a box, prevents clear yang from rising, turbid yin from descending, and qi movement is blocked. Dried ginger is pungent and warm, warms the spleen and yang to promote clearness. Coptidis enters the heart, Scutellaria baicalensis enters the lungs, and the two medicines are bitter and cold to dry damp and heat to reduce turbidity. Coptis chinensis controls the small intestine, Scutellaria baicalensis controls the large intestine, and the two medicines cleanse the dampness and heat in the intestinal tract to stop benefit. Accompanied by jujube to strengthen the intestinal tract, and licorice for emergency. If the qi movement is stagnant, turbid qi will be generated in the stomach, so licorice is used to detoxify. Pinellia opens knots to subdue adversity, and ginseng invigorates the middle and nourishes Qi, so that righteousness will come and go, and the up and down will communicate, and the ruffian will be relieved by itself.

If water evil gathers in the stomach, going up against it means vomiting, and going down means borborygmus. Therefore, adding ginger Jiangni Sanshui is also called ginger Xiexin Decoction. If the turbid and poisonous gas in the stomach is strong, it will erode the mouth upwards and erode the two yins downwards. Both upper and lower are sick, and the treatment should be in the middle, so licorice is used to detoxify, which is also Gancao Xiexin Decoction.

There has been no reliable basis for the origin of "fox confusion disease", but two folklore can be referred to. According to legend, there is a kind of worm that lives in the anus and can cause sores in the anus and urethra. In addition, the ancients believed that foxes were prostitutes, and male foxes often turned into men to have sex with human women, absorbing their energy and corrupting their integrity, and could also cause sores at the vaginal opening of women. It is written in many medical books that "the upper erosion of the mouth is confusion, and the lower erosion of the two yin is a fox". I can't define it accurately, so let's use this theory as a reference.

In addition, many physicians have suggested that cold and heat are opposite in nature, and it is impossible for there to be "interaction". My personal understanding is that cold is deficiency and cold, and spleen deficiency and cold produce dampness; heat is superficial heat, that is, stagnant heat; Therefore, the bitter and cold medicine is used to clear away heat, and the warm medicine is used to remove dampness. The purpose of using Scutellaria baicalensis and Coptis chinensis instead of other medicines is that Erhuang has the effect of clearing away heat and dampness.

The syndromes of this formula are not easy to classify from the perspective of syndrome differentiation of the six meridians. There are both Yangming disease and Taiyin disease, Shaoyang disease and Jueyin disease. It belongs to the neutral gray between black and white. I personally think it is between Shaoyang disease and Jueyin disease. Clinically, it should be carefully examined. Those with deficiency and coldness can be attributed to Jueyin disease, and those with excess heat can be attributed to Shaoyang disease. Some doctors believe that the upper heat and the lower cold are Jueyin diseases, and some are too sticky. It is true that Jueyin diseases are mostly hot in the upper part and cold in the lower part, but not all of them are Jueyin diseases. In fact, it is secondary to the disease. The syndrome itself is both cold and heat, deficiency and excess, as long as it can solve the problem of abnormal ascending and descending of the spleen and stomach. Those who are famous are empty.

In addition to spleen and stomach lesions, there are also those who have abnormal ascending and descending caused by dysfunction of other viscera and then affect the middle burner. For example, abnormal ascending and descending caused by external evil, the treatment should be to relieve the exterior, and treat it from the lungs; if the kidney is unfavorable to qi transformation, the treatment should be to warm the yang and transform qi, and treat it from the kidney. Only by fully understanding the mechanism of abnormal lifting can it be certified that there is no difference.