柴胡疏肝汤

4. Common modifications

• Qi constraint transforming into fire, with bitter taste in the mouth and red tongue: Add Zhi Zi (gardenia fruit), Dan Pi (moutan bark), and Chuan Lian Zi (toosendan fruit) to clear the Liver and drain fire.
• Liver qi invading the Stomach, with frequent nausea and vomiting: Add Ban Xia (pinellia rhizome), Sheng Jiang (fresh ginger), and Su Geng (perilla stem) to harmonize the Stomach and direct rebellious qi downward.
• Concurrent blood stasis, with needle-like pain: Add Dang Gui (Chinese angelica root), Tao Ren (peach kernel), and Hong Hua (safflower) to strengthen the action of invigorating blood and dispelling stasis.
• Concurrent food stagnation, with belching of rotten odor and acid regurgitation: Add Shen Qu (medicated leaven) and Mai Ya (germinated barley) to disperse food and guide out stagnation.
• Modern applications: This formula is commonly used for chronic gastritis, gastric and duodenal ulcer, chronic hepatitis, cholecystitis, intercostal neuralgia, mammary gland hyperplasia, and dysmenorrhea that belong to the pattern of Liver constraint with qi stagnation.

5. Cautions

• Contraindications:
  • This formula is acrid and drying, and may readily consume qi and damage yin; it is not suitable for prolonged use.
  • Use with caution in cases of yin deficiency with scanty blood, or ascendant Liver yang, presenting with a red tongue with scanty coating, dry mouth and throat, and dizziness with blurred vision.

6. Granule conversion and dose

• Calculation of the total raw herb weight of the original formula:
  • Chai Hu (bupleurum root) 6 g + Xiang Fu (cyperus rhizome) 4.5 g + Chuan Xiong (chuanxiong rhizome) 4.5 g + Zhi Ke (bitter orange fruit) 4.5 g + Bai Shao (white peony root) 4.5 g + Chen Pi (aged tangerine peel) 6 g + Zhi Gan Cao (honey-fried licorice root) 1.5 g = 31.5 g.
• Conversion to 5:1 granules:
  • 31.5 g raw herb ÷ 5 = 6.3 g granules.
• Recommended dose:
  • One dose daily, taken dissolved in warm water in two portions, morning and evening, about 3 g per dose.
  • Or as directed by the practitioner, who will make modifications according to the relative emphasis of qi stagnation and blood stasis and any concurrent patterns present, in which case the total raw herb weight must be recalculated after adjustment.