Months ago I promised a post about the quintessential example of Chinese herbalism’s ‘harmonizing formula,” Xiao Chaihu Tang (Minor Bupleurum Decoction). I’ve been rather pre-occupied with other aspects of my medical studies–in fact I’ve been paddling around in the esoteric end of the pool these last months, working with plant spirits and meditative states and the Yi Jing. But things have a way of coming back around, and when I succumbed earlier in the week to the nasty cold that’s been circulating, I needed Xiao Chaihu Tang.
The common cold is notoriously difficult to treat, because it comes in an almost endless variety of forms. In fact the skeptical saying goes something like “treat a cold correctly, it’ll resolve in a week. Otherwise, it’ll last seven days.” Well I’m proud to say I got this one beat in 3 or 4. How did I know Xiao Chaihu Tang was my weapon of choice? It’s all in the yang. The shaoyang, to be exact.
For those uninitiated in the mysterious arts of the Shanghan Lun’s 6 conformations, shaoyang is considered the pivot between the yang conformations–outside–and the yin ones–inside. Shaoyang is tricky; it’s the in-between spaces in the body, including the lymph. It’s fire, but not blazing fire (that would be too easy to recognize and to treat); shaoyang pathology involves stuck fire. In shaoyang disease, things are gummed up, stagnant, just plain gunky. And hard to pin down. In terms of signs and symptoms, there may be sore throat, red eyes, dizziness, ear symptoms; fullness under the ribs, irritability, and pain along the sides of the head and body ; alternating hot and cold, bitter taste in the mouth, a notably wiry pulse especially on the left side and a tongue with red sides. Any one of these symptoms can be enough to tip one off the presence of a shaoyang condition, and if you have more than one it can be considered cut-and-dried.
In my case, my cold started with a scratchy, tickly sore throat and oddly irritated eyes. It had no real taiyang (aversion to wind, chills, stiff neck) or yangming channel signs (nasal congestion, frontal headache, etc.); it was pretty purely shaoyang. And sure enough, as the representative remedy for the shaoyang layer, Xiao Chaihu Tang promptly worked its magic.
Let’s take a closer look at the formula. It contains Chaihu (Bupleurum), Banxia (Pinellia), Huangqin (Scute), Renshen (Ginseng or Codonopsis), Shengjiang (Fresh Ginger), Dazao (Jujube), and Gancao (Licorice).
At first glance, it’s ‘neither here nor there.’ Not wholly tonic, not wholly dispersing; not too warm not too cold…but that’s just it! It personifies balance and finesse. It moves while fortifying and lifts while descending. In a word, it harmonizes.
As the emperor herb, Chaihu is responsible for targeting the shaoyang layer and for dispersing the stagnant qi that is pretty much a given in shaoyang disease. But Chaihu is not acting alone here; Banxia follows close behind to bust up any phlegm that has accumulated in the wake of the stagnant qi, and Huangqin clears the heat that comes from stagnation. Together these three herbs neatly treat both root and branches of the condition and clear up the qi layer.
From a five phase perspective, this de-stagnating of the qi fits nicely into the Wood phase, as the first three herbs of the formula are about re-establishing proper motion. But what are the other four, resoundingly earthy herbs doing in the mix? Why would we want to tonify in a case like this? Herein lies the genius of the formula.
We know from the Neijing Suwen that when the Wood is diseased, the superior physician looks to the Earth element because it will be the next to feel the impact. Wood controls Earth, and that control too easily turns to ‘overcontrol.’ So on one level the use of Renshen, Shengjiang, Dazao and Gancao serves to protect the Earth. They also balance out to some extent the drying effects of the first three herbs and encourage the transformation of fluids. They warm the middle while the three lead herbs de-stagnate the interstices. In short, they make the formula into one safe and suitable for moderately long-term administration without compromising clinical efficacy. This is what Heiner Fruehauf refers to as “alchemical stability” — this almost magical balance that allows a formula to act as more than the sum of its parts in terms of efficacy while minimizing the undesirable effects of any of the individual herbs.
Unmodified Xiao Chaihu Tang is one of the most frequently prescribed formulas in Japanese Kampo medicine, and it should be near the top of every practitioner’s list of go-to prescriptions. There should be a saying, “when in doubt, use Xiao Chaihu Tang,” because it’s just that useful. And we haven’t even gotten into the ‘off-label’ uses!