Chai Hu Wen Dan Tang Modified and its Clinical Application

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By Dr Greta Young Jie De

As its name implies, Chai Hu Wen Dan Tang is a combination of two formulas: Xiao Chai Hu Tang and Wen Dan Tang.

Xiao Chai Hu Tang: This famous harmonising formula has its origin in Clause 96 of Shang Han Lun (Discussion of Cold Damage) which says:

“Shang han zhong feng for five or six days, alternating chills and fever, if there is pain and fullness in the chest and ribs, no desire to talk or for food or drink, vexation and nausea, or vexation in the chest with no vomiting, or thirst, or pain in the abdomen, or hard glomus beneath the ribs, or palpitations below the heart and urination which is not free, or no thirst and a slight fever, or a cough, Xiao Chai Hu Tang governs”.   

Xiao Chai Hu Tang is a formula which addresses a complex of heat and cold, simultaneously dispelling the pathogen and supporting the zheng qi. By clearing heat and dispersing the obstruction of the triple jiao, it restores the qi dynamic and harmonises the Shao Yang. Because it is a great formula to harmonise the qi dynamic, it is a commonly used and effective formula not only for externally-contracted febrile disease but also for a wide range of interior conditions in the modern clinical setting.

Ingredients: Chai Hu, Huang Qin, Ban Xia, Sheng Jiang, Ren Shen, Zhi Gan, Da Zao.

Wen Dan Tang:

This well-known phlegm dispelling formula was first recorded in the Northern Zhou Dynasty in Yao Zeng Yuan’s Ji Yan Fang (Collection of Tested Formulas ) and later incorporated in Wang Tao’s Wai Tai Mi Yao (Essential Secrets from the Imperial Library) where it is found in Volume 17. The modern use of Wen Dan Tang originated in Chen Yan’s Song dynasty text (San Yin Ji Yi Bing Zheng Fang Lun (Three Key Factors of Disease Pattern Formulas).

Ingredients: Ban Xia, Zhu Ru, Zhi Shi, Chen Pi, Fu Ling, Gan Cao, Sheng Jiang, Da Zao.

Wen Dan Tang is indicated for deficiency of the heart and gallbladder causing timidity. The emotional aspects of the pattern are attributed to qi constraint with ensuing generation of phlegm, damp, and heat. Phlegm heat disturbs the gallbladder and harasses the heart shen. This then manifests as restlessness, anxiety, irritability, and insomnia, which are accompanied by other symptoms such a shortness of breath, a poor appetite, oedema, spontaneous sweating and palpitations. It is used in cases of phlegm heat patterns affecting the qi dynamic associated with emotional stress, poor recovery from illness where zheng qi deficiency and poor convalescent care have resulted in damp or phlegm accumulation, and in patterns of exterior damp heat where there has been subsequent transformation to phlegm heat.

Chai Hu Wen Dan Tang:  This formula is found in the Ming dynasty text Jing Yue Quan Shu (Completion Collection of Jing Yue) and combines the clinical effects of the two important harmonising formulas, Xiao Chai Hu Tang and Wen Dan Tang. Xiao Chai Hu Tang is used both in Shang Han (Cold Damage) and in Wen Bing (Warm Disease) disorders. In Shang Han it is addresses the foot Shao Yang or Gallbladder channel while in Wen Bing it is the hand Shao Yang or San Jiao channel which is addressed, thus focusing on the triple jiao.

 Ingredients: Chai Hu, Huang Qin, Ban Xia, Zhi Shi, Chen Pi, Zhu Ru, Gan Cao, Sheng Jiang, Da Zao.

Points to bear in mind when using Chai Hu Wen Dan Tang:

  1. Phlegm heat impeding the pivot mechanism and harassing the clear orifices. The foot Shao Yang channel traverses the head, ears and eyes. The upsurge of gallbladder fire or the steaming of damp by heat will obstruct and “mist” the clear orifices. In addition, because the hand Shao Yang triple jiao serves as a pathway for the movement of fire, qi and water, constrained fire will in turn obstruct the normal passage of qi, fire and water.
  2. Gallbladder fire is the ministerial fire. Ministerial fire was discussed in detiail in Zhu Dan Xi’s Ge Zhe Yu Lun (Extra Treaties Based on Investigation and Inquiry.) where he said “The theory of ministerial fire said that it resides in the liver and kidney and moves between the gallbladder, the urinary bladder and the triple jiao, causing obstruction of the triple jiao.”

  Case Study 1: Vertigo

A 66 year old woman had suffered from vertigo for one month. She as had tremors when walking and her ears felt blocked, affecting her hearing. Her appetite, urination ad stool were all normal. Her tongue coat was white and slightly thick and her pulse was wiry and moderate. Her biggest problem was the tremor when she was walking, and her fear of falling prevent her from many activities. She also had difficulty in using chopsticks because of the tremor of her hands.

Vertigo and tinnitus can be attributed to impaired Shao Yang pivot mechanism with disharmony of the triple jiao resulting in wind phlegm harassment so a formula based on the strategies of harmonising and resolving phlegm heat as found in Chai Hu Wen Dan Tang were called for.

Ingredients: Chai Hu 10g; Huang Qin 10g; Ban Xia 10g; Chen Pi 10g; Fu Ling 30g; Zhu Ru 10g; Zhi Shi 15g; Jiang Can 10g; Chen Tui 10g; Lai Fu Zi 10g; Gou Teng 10g. Seven packs.

After three packs her vertigo improved but her tinnitus persisted, fluctuating from mild to serious. It was apparent that the phlegm heat was only slightly resolved. And at the second consultation, she was given a modification of Chai Hu Ling Gui Zhu Gan Tang.

Ingredients: Chai Hu 10g; Huang Qin 10g; Ban Xia 10g; Tai Zi Shen 15g; Fu Ling 30g; Gui Zhi 10g; Bai Zhu 10g; Zhi Gan Cao 6g; Lai Fu Zi 10g; Gou Teng 30g; Tu Yuan 10g.  After sven packs her vertigo was fully resolved and her tinnitus much improved.

Case Study 2: Insomnia

A 14 year-old school girl suffered from insomnia and depression associated with her menstrual cycle which had been prolonged (30 days-40 days) since her menarche 2 years earlier. She had menstruated four times in the previous six months, and each time she had felt depressed and had her insomnia worsened to the point where some nights she did not sleep at all. Her memory and concentration were also greatly affected and her appetite was poor. She had a moderate pulse and a thick, greasy tongue coat. The diagnosis was phlegm heat accumulation harassing the heart shen, and the treatment principle was to harmonise the Shao Yang, clear heat and transform phlegm. Chai Hu Wen Dang Tang was appropriate.

Ingredients: Chai Hu 10g; Huang Qin 10g; Ban Xia 10g; Chen Pi 10g; Fu Ling 30g; Zhu Ru 10g; Zhi Shi 10g; Lai Fu Zi 10g; Ze Xie 10g; Mu Li 15g. Seven packs.

Clinical notes: This patient had damp heat and phlegm with phlegm heat harassing the heart shen causing insomnia. Chai Hu and Chen Pi disperse constrained liver and regulate qi; Huang Qin, Ban Xia, Fu Ling, Zhu Ru , Lai Fu Zi and Zhi Shi tonify the spleen and parch dampness as well as clearing heat and transforming phlegm; Ze Xie drains turbidity while Mu Li astringes and calms the heart shen.

About Dr Greta Young Jie De

Greta Young Jie De is a registered Chinese Medicine practitioner with the Chinese Medicine Registration Board Australia, with a focus on the treatment of emotional disorders using Chinese medicine. She is an expert in the classic literature of Chinese…Read more

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