As winter is approaching in Australia, Pearls of Wisdom would like to feature three of Tong Ren Tang’s products for the month of June with the focus on how to deal with a contraction of cold.
From the Chinese medicine perspective, it is essential to diagnose the pattern before prescribing the herbal formula whether it be a cold due to wind-cold or wind-heat. [Suwen: Zhi Zhen Yao Da Lun Chapter 74] said: “ Treat the cold with heat and treat the heat with cold寒者热之， 热者寒之“. Therefore irrespective the disorder is an external contraction or an internal injury, this theory is applicable to the majority of disorders and diseases.
Ganmao Qingre Granules Aust L 124661
Ingredients: Jing Jie, Bo He, Fang Feng, Chai Hu, Zi Su, Ge Gen, Jie Gen, Ku Xing Ren, Bai Zhi, Ku Di Ding, Lu Gen.
Indications: Disperse wind and dissipate cold, relieve exterior, clear heat for wind cold contraction characterised by headache, fever, aversion to cold; generalised ache; clear nasal discharge, cough and dry throat.
Analysis of the formula: Jing Jie, Fang Feng and Bo He are wind herbs and the effect is to dispel wind and release exterior. In particular Jing Jie is acrid and warm with a lifting nature, poised to promote sweating, dispel wind and release exterior. It is indicated for constraint of pathogenic wind cold at the exterior characterised by headache, no sweating, generalised ache. This is a pattern reflecting exterior blockage. Jing Jie is often combined with Fang Feng. Jing Jie is very light which facilitates the ascending action, enhancing its effect on the head and clear orifices, as well as its effect on disinhibiting the throat. When pathogenic wind harasses the head and the five orifices, the result can be vertigo, nasal blockage, or blurry vision. By dispersing wind, Jing Jie can restore the normal function of the five orifices. It must be noted that since Ma Huang is banned in Australia, the combined effect of the wind herbs bear similar function.
- Jie Gen: It can diffuse the lung qi and downbear lung qi. When Jie Gen is combined with Xing Ren, it helps the lung qi to downbear and stop cough.
- Zi Su: Release exterior, dissipate cold, regulate qi and harmonise ying; the seed of Zi Su has a depurating effect on the lung qi while the hollow stem known as Su Geng can transform phlegm and loosen chest oppression due to phlegm obstruction.
- Di Ding: Clear heat and relieve toxicity.
- Chai Hu: Disperse and vent the interior toxicity by diffusing the qi dynamic
- Lu Gen: Nourish fluids and has a mild heat clearing effect.
Tong Ren Tang’s Ganmao Qingre Granules bears similarity to the formula known as Bai Du San originated from the Song paediatrician Qian Yi and also the modified version of Bai Du San known as Jing Fang Bai Du San from “She Sheng Zhong Miao Fang摄生众妙方”. Both these formulas are indicated for the treatment of external contraction of wind cold and damp. Jing Fang Bai Du San contains Qiang Huo and Du Huo targeting dampness while Ganmao Qingre Granules is mainly focused on releasing exterior and toxin relieving. From the modern medicine perspective it can be regarded as an anti-pyretic and anti-virus medication while from the Chinese medicine perspective it is a medication targeting exterior contraction of wind-cold.
What is the concept of exterior contraction? In accordance with the Chinese Medicine diagnosis, the main clinical features are fever, aversion to cold and a floating pulse. This concept covers a large scope of disorders including the common cold as well as viral infectious diseases.
TCM theory suggests the six excesses, ie wind, cold, summer heat, dampness, dryness and fire are the key factors of external contraction with the pathogenic qi harassing the skin and hair via the nose and mouth with damage to the respiratory system incorporating the mouth, nose, throat and bronchial tubes characterised by generalised effusion, aversion to cold, muscle and joint aches, localised nasal blockage, nasal discharge, sneezing, cough and swollen and painful throat.
The corresponding treatment is to focus mainly on expelling the pathogen. The composition of Bai Du San or Jing Fang Bai Du San is to facilitate the exit of pathogen by using wind herbs, the use of Jie Gen as a guide herb targeting the upper jiao and the use of Bo He to dissipate wind for treatment of headache. The ingenious use of Chai Hu in the formula has a deep and underlying objective. During the course of an external contraction, there can be transformation of cold and heat, there is a tendency for exterior pathogenic cold pattern to transform into heat with the patient suffering from a condition of more heat than cold. Thus the use of Chai Hu is to pre-empt the possible transformation from cold to heat since Chai Hu is poised to vent pathogenic heat from the interior to the exterior.
Modern Research: Modern pharmacological studies have shown that Ganmao Qingre Granules is anti-pyretic, analgesic, anti-inflammatory, anti-viral, anti-bacterial, thus having an effect to improve immune cell activity. Clinical applications are for the treatment of upper respiratory tract infections, influenza, infantile autumn diarrhea, hives etc.
Jiang x, 26 year-old male presented with fever, headache, aversion to cold, no sweating, body temperature 39.2 degree C, nasal blockage, cough, chest oppression, aching limbs, white, moist tongue coat and a floating and taut pulse.
Prescription: Jing Fang Bai Du San modified: Jing Jie 4.5g; Fang Feng 4.5g; Qiang Huo 4.5g; Chai Hu 9g; Qian Hu 6g; Jie Gen 6g; Bo He 3g; Bai Zhi 6g, Xing Ren 9g. Two packs.
After the medication, his fever receded and his cough was reduced. Continue with the same medication for a further two packs. He recovered.
Comments: Instead of the modified prescription above, Tong Ren Tong’s Ganmao Qingre Granules Aust L 124661 may be prescribed for the wind-cold contraction. A combination with Banlangen Granules is recommended to enhance the therapeutic effect.
Direction for Ganmao Qingre Granules:
- Take orally with warm water 1 sachet per time 2~3 times daily.
- Drink more warm water to promote sweating while avoid dehydration due to excessive sweating.
Cautions and Contraindications:
- Not suitable for the wind-heat type of cold contraction.
- Patients suffering from hypertension, cardiopathy, liver disease, nephropathy, or pregnancy or taking other medications should consult the practitioner.
- Refrain from spicy, chilled or greasy food during the course of medication.
- If symptoms persist, consult your practitioner.
Yin Qiao Jie Du Pian (Honeysuckle Tablet) Aust L 115579
Yin Qiao Jie Du Pian is designed for treatment of externally-contracted disorder due to wind-heat. It is according to the Wen Bing specialists an acrid, cool releasing exterior formula. It was created by the renowned Wen Bing specialist Wu Ju Tong during the Qing Dynasty. Yin Qiao Jie Du Pian is indicated for a wind-heat exterior pattern characterised by fever, slight aversion to wind, sweating, headache, parched and painful throat or swollen tonsil, nasal blockage, phlegm, red tongue with red tongue tip and margin, thin white or slightly yellow tongue coat and a floating and rapid pulse.
Ingredients: Yin Hua, Lian Qiao, Bo He, Jing Jie, Dan Dou Chi, Niu Bang Zi, Jie Gen, Dan Zhu Ye, Gan Cao.
Action: Acrid cool to release exterior, clear heat and relieve toxicity.
Indications: Yin Qiao Jie Du Pian is most typically used in the treatment of the initial stage of upper respiratory tract infection associated with the invasion of wind heat, and commonly characterised by a sore throat and coughing. In addition to the common cold, influenza, bronchitis and tonsillitis, its further application extends to measles and mumps, and also to hay fever, and skin disorders such as urticaria, eczema and allergic dermatitis, etc
- Jin Yin Hua is sweet and cold; Lian Qiao is acrid, bitter and cool. Together they clear heat and relieve toxicity
- Jing Jie and Dan Dou Chi are acrid and warm; Bo He, Niu Bang Zi and Lian Qiao are acrid and cool. The combined action of these herbs disperses and vents wind heat, and thus relieving the exterior constraint caused by the pathogen.
- Jie Gen and Niu Bang Zi both diffuse lung qi
- The combination of Jie Gen, Sheng Gan Cao, Niu Bang Zi and Bo He dissipates bind and disinhibits the throat
- Zhu Ye is sweet and cold, and clears heat by disinhibiting urination to guide heat downwards
Yin Qiao Jie Du Pian: Additional points of interest:
- One might ponder the purpose of introducing the two acrid warm herbs (Jing Jie Sui and Dan Dou Chi) into a formula which is otherwise composed of cool and cold herbs. Both, of course, assist the other acrid herbs in releasing the exterior. Jing Jie Sui is acrid, aromatic, and although slightly warm, is not drying. It not only expels wind from the wei and qi aspects, but also expels wind from the blood aspect, and is thus used as a key herb to vent skin rashes.
- Dan Dou Chi is acrid and bitter, and can be warm or cool, depending on the method of preparation. Its acridity enables it to vent the exterior, and its bitterness allows it to clear constrained interior heat. Prepared with Qing Hao and Sang Ye, it is known as ‘Xiang Dou Chi’ (aromatic fermented bean) and is aromatic and cold. It is this form that is used in Zhi Zi Chi Tang, the purpose of which is to clear constrained heat from the upper jiao. When prepared with Ma Huang and Zi Su Ye it takes on the warm properties of those herbs, and is then suitable for expelling wind cold.
- When a patient presents with toothache or inflamed gums, the initial stage of a skin rash or itching lesions, attributed to wind fire in the interior, additional wind herbs can be added to Yin Qiao San because by dispelling the wind and by their venting action, they will also help to relieve the constrained fire. If, however, the pathogenesis of skin lesions, boils or ulcers is constrained fire in the blood aspect, then blood cooling herbs such as Sheng Di Huang, Xuan Shen, Chi Shao and Mu Dan Pi, or Xi Jiao Di Huang Tang can be used to cool and invigorate blood.
Case Study 1: Urticaria
A 27 year-old male had contracted a cold a few days before, and his body was now covered with blistery skin lesions. Examination found he had fever, a dry mouth and was constipated. His tongue was red with a thin white coat, and the pulse was floating and rapid. The diagnosis was a wind heat attack affecting the wei aspect. In Wen Bing terms, this is a Wind Warmth or Spring Warmth disorder. The treatment principle was to disperse wind and clear heat.
Prescription: Yin Qiao San or Yin Qiao Jie Du Pian modification
Ingredients: Jing Jie 6g; Fang Feng 6g; Sang Ye 10g; Ju Hua 15g; Ku Shen 10g; Lian Qiao 15g; Huang Qin 10g; Xuan Shen 10g; Di Fu Zi 15g; Bai Xian Pi 15g; Chan Tui 6g (5 packs).
He returned for a second consultation one week later. The fever, dry mouth and constipation were all resolved but there was some residual redness in the fingers. The same formula was prescribed omitting Huang Qin and Ku Shen and adding Zi Cao 10g (5 packs).
Discussion: This is a typical pathogenic wind heat pattern with the pathogenic influence constrained between the muscle layer and skin interstices (cou li), manifesting as a raised papular rash (zhen). The disorder is primarily in the superficial layers and therefore treatment should focus on dispersing wind and clearing heat from the exterior. Jing Jie and Fang Feng disperse wind and open the skin pores; Sang Ye, Ju Hua and Lian Qiao disperse wind and clear heat; Ku Shen and Huang Qin clear heat and parch dampness. Xuan Shen was added to address the red tip in the tongue and to nourish yin. Chan Tui, Di Fu Zi and Bai Xian Pi disperse wind, drain damp and relieve toxicity to stop the itch.
Modern Research: Research studies have proved that Yin Qiao Jie Du Pian is anti-pyretic, analgesic, anti-inflammatory and anti-viral with the effect of inhibiting the proliferation of bacteria.
Comments: Instead of the modified prescription of Yin Qiao San or Yin Qiao Jie Du Pian above, Tong Ren Tong’s Yin Qiao Jie Du Pian Aust L 115579 may be prescribed.
Direction for Yin Qiao Jie Du Pian Aust L 115579: Take orally 3 pills each time, twice daily with warm water.
- Not suitable for wind-cold type of cold contraction characterised by strong aversion to cold, slight fever, no sweating, absence of sore throat or cough with clear and watery sputum.
- Use only as directed by practitioner for children under 2 years old.
- Consult your practitioner if on other medication.
- Refrain from spicy, cold or greasy food during medication.
- If symptoms persist, consult your practitioner.
Banlangen Granules (Sugar–free) AUST L 124663
Banlangen Granules is traditionally used for relieving symptoms of influenza. It is also used to relieve sore and painful throat associated with tonsillitis.
Ingredients: Ban Lan Gen (Radix Isatidis).
Ban Lan Gen is the root of Isatis Indigotica Fort and is a native product of China. It has been used for over 2000 years as a key herb in the management of external contraction of cold due to heat.
Modern Research: Researches showed that Banlangen is very effective as an anti-virus medication.
Case Study: Infantile cough
Wang xx, 9 year-old female presented with a cold a few weeks ago, and unexpectedly her cold was not resolved after several weeks. She suffered from persistent cough, fever, nasal discharge with expectoration of yellow and sticky phlegm.
Examination of S/S: Painful and swollen tonsil, cough, red tongue with yellow tongue coat and a rapid pulse.
Diagnosis: Wind-heat cough (Upper Respiratory Tract Infection)
Prescription: Huang Qin 10g; Ban Lan Gen 12g; Jin Yin Hua 8g; Lian Qiao 8g. Decoct in water to get 200 ml of liquid. Take warm twice daily for five days.
Analysis: Huang Qin and Ban Lan Gen are herbs frequently used by Chinese medicine practitioners for purpose of clearing heat and relieving toxin. Huang Qin is bitter and cold, clears heat and parch dampness, purge fire indicated for damp-heat glomus, cough due to lung heat congestion or vigorous fever with vexation thirst; Ban Lan Gen is also bitter and cold, clears heat, disinhibit the throat, cool blood and relieve toxicity; Jin Yin Hua is sweet ,aromatic and slightly cold, clears heat, relieves toxicity, cool blood and transform stasis; Lian Qiao is bitter and slightly cold indicated for early onset of febrile diseases such as common cold, fever and swollen throat. The whole formula is anti-bacterial and anti-inflammatory.
The patient recovered after taking five packs of medication. Continue to consolidate by taking moistening and nourishing yin food as well as tonifying the spleen and lung.
The above formula is indicated for children of 8 year-old and above. As for children below the age of 8, the dosage should be reduced accordingly. It must be remembered that both Ban Lan Gen and Huang Qin are bitter and cold and the formula is not suitable for patient with weak spleen and stomach.
Comments: Tong Ren Tong’s Banlangen Granules (Sugar–free) AUST L 124663 alone may be prescribed, or in combination with other medication to enhance therapeutic effect.
Directions for use of Banlangen Granules (Sugar–free) AUST L 124663: Take orally with warm water. Take 1 or 2 sachets each time, up to 3~4 times daily.
- Not suitable for common cold caused by wind-cold.
- Not to be taken by children under 2 years of age, pregnant woman or patients with chronic illness without medical supervision.
- If symptoms persist, consult your practitioner.
- Consult your practitioner before use if this is to be taken with other medications.
- Refrain from spicy, chilled or greasy foods.
The above information has not been assessed or approved by the TGA, and it is designed for TCM practitioners’ education and training purpose only. Public consumers are recommended to seek TCM diagnosis and consultation before using the products.
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 »