Filed under Xie Xin Tang
Clinical Application of the Five Xie Xin Tang Formulas in the Treatment of Gastro-intestinal Disease
By Professor Fu Yanling
Glomus is defined as a subjective sensation of qi blockage in the middle jiao, which disturbs the ascent and descent of spleen and stomach qi. Glomus patterns are characterized by fullness and qi obstruction below the heart. According to Shang Han Lun, the Xie Xin Tang formulas are indicated in the treatment of glomus patterns and comprise the following:
- Ban Xia Xie Xin Tang
- Sheng Jiang Xie Xin Tang
- Gan Cao Xie Xin Tang
- Da Huang Huang Lian Xie Xin Tang
- Fu Zi Xie Xin Tang
The pathogenesis of glomus is an abnormal disturbance in the ascent and descent of the spleen and stomach qi attributed to obstruction resulting from qi stagnation. The spleen is located in the middle and serves as a pivot for the movement of qi. The spleen governs ascent while the stomach governs descent. The raising function of the spleen facilitates the ascent of the clear yang while the descending function of the stomach is facilitates the descent of turbidity. Thus the functions of the spleen and stomach are interdependent and together they ensure that the qi dynamic is normal.
Irrespective of whether we are looking at disease in the historical past or in the contemporary age, glomus patterns are clinically common and are the basis of many diseases which are now diagnosed as gastro-intestinal diseases. Traditionally, based on Shang Han Lun, glomus patterns can be categorised as follows:
- Heat glomus (includes heat glomus with exterior yang deficiency)
- Cold glomus
- Complex heat and cold glomus
- Phlegm qi glomus
- Water Qi glomus
- Food stagnation glomus
- Heat Glomus
Heat glomus is characterised by a subjective sensation of qi blockage due to formless heat below the heart. It includes the pattern of heat glomus with exterior yang deficiency characterised by aversion to cold and sweating.
Cold glomus is a result of obstruction due to accumulation of cold in the midde, blocking qi and causing stagnation.
Complex heat and cold glomus
Heat and cold complex describes a mixture of heat and coldcharacterised by heat in the upper jiao and coldness in the lower jiao which leads to the bloackage of qi.
Phlegm Qi glomus
Phlegm qi glomus describes obstruction of qi and phlegm caused by qi stagnation below the heart (referring to the epigastric region) and the subsequent formation of phlegm.
Water Qi glomus
There are two patterns of water qi glomus:
- Water retention in the lower jiao due to impaired qi transformation, characterised by dryness in the stomach with subsequent disharmony of the stomach qi and glomus
- Watery fluid retention below the heart leading to glomus and qi blockage.
Food stagnation glomus
Food stagnation glomus results from the failure of the stomach to assimilate and digest of food, causing epigastric fullness and glomus.
Characteristics of Heat Glomus and its Treatment
Signs and symptoms: Glomus below the heart which is soft on palpation, dark urination, dry or difficult bowel movement or blood in the stool, vomiting, retching or hemoptysis, bleeding gums, redness in the eyes, a red tongue, a yellow tongue coat, a floating guan pulse or a slippery or rapid pulse, a red complexion. The bowel movement may be normal.
Treatment: Purge heat and alleviate glomus.
Formula: Da Huang Huang Lian Xie Xin Tang
Da Huang, Huang Lian (Huang Qin). Infuse the herbs in boiling water to moderate the cold natureand bitter taste of the herb and reduce the affect on the lower jiao.
Characteristics of Heat Glomus with Exterior Yang Deficiency
Signs and symptoms: Similar to heat glomus but with the additional manifestations of aversion to cold and spontaneous sweating.
Treatment: Purge heat and alleviate glomus; warm and revive the exterior yang.
Formula: Fu Zi Xie Xin Tang
InfuseDa Huang, Huang Lian and Huang Qin in boiling water; boil Fu Zi separately to extract the juice, thenadd the juice to the decoction and take it warm.
Fu Zi not only warms the exterior yang but also effectively warms the chest yang and disperses cold and warms the yang of the abdomen as well as warming the kidney yang. Thus, Fu Zi Xie Xin Tang is indicated for heat glomus with exterior yang deficiency and for chest yang and abdominal deficiency, especially where there are signs of kidney yang deficiency. This formula can be modified to treat heat glomus with exterior or interior yang deficiency.
Complex Heat and Cold Glomus
Signs and symptoms: Glomus below the heart, nausea and vomiting, diarrhoea, manifestations of both heat and cold.
Treatment: A combination of hot and cold herbs to acridly disperse and bitterly discharge, thus harmonising the middle and alleviating the glomus.
Formula: Ban Xia Xie Xin Tang
This is a key formula of the Xie Xin formulas and can be used to treat a variety of diseases.
Complex Heat and Cold accompanied by Food Stagnation and Water Retention
Pathogenesis: The disease location is below the heart with a complex of stomach heat and spleen cold which disturbs the normal ascent and descent of the spleen and stomach, resulting in non-transformation of water and subsequent food stagnation.
Signs and symptoms: Hard glomus below the heart, nausea and vomiting, putrid belching, diarrhoea, intestinal rumbling.
Treatment: Simultaneous use of warm and cold herbs, acrid herbs to open and bitter herbs to discharge, in order to dissipate water retention, reduce food stagnation; harmonise the middle and alleviate the glomus.
Formula: Sheng Jiang Xie Xin Tang
Sheng Jiang is effective in eliminating water retention, as exemplified by Fu Ling Gan Cao Tang. Professor Liu Du Zhou used Fu Ling Gan Cao Tang to treat a patient with water retention in the stomach and used the juice of Sheng Jiang added to the decoction to reduce excess water in the stomach.
Complex Heat and Cold Glomus accompanied by severe Spleen and Stomach Qi Deficiency
Pathogenesis: Incorrect or inappropriate treatment of a complex heat and cold syndrome or incessant diarrhoea which has further damaged the spleen and stomach qi.
Signs and Symptoms: Hard, full glomus below the heart, dry retching, heart vexation and restlessness, incessant and severe diarrhoea with undigested food particles and rumbling intestines resulting in fatigue, shortness of breath and heart palpitations.
Treatment: Simultaneous use of warm and cold herbs, acrid herbs to open and bitter herbs to discharge; tonifyand augment the middle qi; harmonise the spleen and stomach and alleviate the glomus.
Formula: GanCao Xie Xin Tang
Ingredients: Zhi Gan Cao 4 liang; Huang Qin 3 liang; Gan Jiang 3 liang; Ban Xia ½ sheng; Da Zao 12 pieces, Huang Lian 1 liang.
Key Point: A large dose of Gan Cao to tonify and augment qi in the middle.
Da Huang Huang Huang Lian Xie Xin Tang
Da Huang, Huang Lian (+ Huang Qin): The decoction method is designed to moderate the harsh nature of the cold, bitter herbs so as to purge the formless heat and alleviate the glomus in the middle jiao. The aim is to targetthe middle jiao rather than the lower jiao.
Fu Zi Xie Xin Tang
Da Huang, Huang Lian (Huang Qin) are infused in boiling water as per the Da Huang Huang Lian Xie Xin Tang instructions in order to purge formless heat. Fu Zi is boiled separately and the extracted juice added to the decoction to regulate and warm the exterior yang.
The Three Xie Xin Tang formulas
- Ban Xia Xie Xin Tang: Ban Xia, Gan Jiang, Huang Qin, Huang Lian, Ren Shen Gan Cao Dao Zao.
- Sheng Jiang Xie Xin Tang: Reduce Gan Jiang to 1 liang and add 4 liang of Sheng Jiang.
- Gan Cao Xie Xin Tang: Use a large dose(4 liang) of Gan Cao so as to emphasize tonification of the middle.
This article was first published after the Pearls of Wisdom Seminar in October 2007