柴胡桂枝汤

3. Tongue and pulse

• Tongue: thin white or thin yellow coating.
• Pulse: floating and wiry (floating indicates the exterior, wiry indicates Shaoyang).

4. Common modifications

• For more severe exterior cold with aversion to cold and no sweating: Fang Feng (siler root) and Jing Jie (schizonepeta) may be added to strengthen the resolution of the exterior.
• For pronounced limb pain: Qiang Huo (notopterygium rhizome) and Du Huo (angelica pubescentis root) may be added to dispel wind and dampness and relieve pain.
  • For epigastric distension and poor appetite: Chen Pi (tangerine peel) and Shen Qu (medicated leaven) may be added to regulate qi and aid digestion.
• Modern applications: This formula is widely used for the common cold, influenza, hepatobiliary disorders, autonomic nervous system dysfunction, epilepsy, menopausal syndrome, chronic fatigue syndrome, and other conditions presenting with the pathomechanism of combined Taiyang-Shaoyang disease.

5. Cautions and clinical notes

• Contraindications:
  • Not suitable for a purely Taiyang exterior excess pattern (Ma Huang Tang pattern) or a purely Yangming interior heat pattern (Bai Hu Tang pattern).
  • Used with caution in cases of yin deficiency with effulgent fire.

6. Granule conversion and dose

• Calculation of the total raw herb weight in the original formula:
  • Chai Hu (bupleurum root) 12g + Gui Zhi (cinnamon twig) 4.5g + Huang Qin (scutellaria root) 4.5g + Bai Shao (white peony root) 4.5g + Ren Shen (ginseng) 4.5g + Ban Xia (pinellia rhizome) 4.5g + Sheng Jiang (fresh ginger) 4.5g + Da Zao (jujube) 3g + Zhi Gan Cao (honey-fried licorice root) 3g = 45 g.
  • (Note: Dang Shen (codonopsis root) is often used clinically in place of Ren Shen, and the dose may be adjusted accordingly.)
• Conversion to 5:1 granules:
  • 45 g raw herbs ÷ 5 = 9 g granules.
• Recommended dose:
  • One dose daily, taken in 2 divided doses, morning and evening, dissolved in warm water, about 4.5 g per dose.
  • Or as directed by a physician, who will modify the formula according to the relative severity of the exterior pattern and the Shaoyang pattern; in that case the total raw herb weight must be recalculated accordingly.