白头翁汤

4. Common modifications

• With concurrent exterior pattern, fever and chills: Add Ge Gen (kudzu root), Jin Yin Hua (honeysuckle flower), and Lian Qiao (forsythia fruit) to release the exterior while clearing the interior (similar in intent to Ge Gen Qin Lian Tang, Kudzu, Scutellaria, and Coptis Combination).
• Severe abdominal pain and tenesmus: Add Mu Xiang (aucklandia root), Bing Lang (areca seed), and Bai Shao (white peony root) to move qi, guide out stagnation, and relax spasm to relieve pain.
• Marked bloody dysentery (severe blood in stool): Add Di Yu (sanguisorba root), Mu Dan Pi (moutan root bark), and Chi Shao (red peony root) to strengthen the action of cooling the blood and stopping bleeding.
• With concurrent food stagnation: Add charred Shan Zha (hawthorn fruit) to disperse food and guide out stagnation.
• Modern application: This formula is commonly used today for amoebic dysentery and bacillary dysentery of the heat-toxin predominant type, often used together with Western anti-infective medication.

5. Cautions and clinical notes

• Contraindications:
  • Absolutely contraindicated in cold-damp dysentery or chronic dysentery of the deficiency-cold type. This presents with thin, watery stool containing white mucus, aversion to cold with cold limbs, and a pale tongue with white coating.
  • Use with caution in patients with Spleen-Stomach deficiency cold, as this formula is intensely bitter and cold and may readily injure Spleen-Stomach yang qi.
  • Because this formula has only weak astringent action, it is not suitable for chronic dysentery that is purely deficient with no pathogenic factor and marked by uncontrolled slipping (fecal incontinence); a warming, astringent formula such as Zhen Ren Yang Zang Tang (True Man Formula for Nourishing the Organs) should be selected instead.
• This formula treats the branch (symptoms); discontinue once the disorder resolves, and do not take it for a prolonged period, so as to avoid injuring yang qi.
• During treatment, the diet should be extremely bland, based mainly on liquid or semi-liquid food, avoiding greasy, spicy, and raw or cold foods.

6. Granule conversion and dose

• Total raw herb weight in the original formula:
  • Bai Tou Weng (pulsatilla root) 15 g + Huang Bai (phellodendron bark) 12 g + Huang Lian (coptis rhizome) 6 g + Qin Pi (ash bark) 12 g = 45 g.
• Conversion to 5:1 granules:
  • 45 g raw herb ÷ 5 = 9 g granules.
• Suggested dose:
  • One dose daily, taken in two portions, morning and evening, dissolved in warm water, about 5 g per dose.
  • Or as directed by a practitioner: for acute severe dysentery, the practitioner may direct 1.5-2 doses daily, taken in 3-4 portions, to maintain blood drug concentration and rapidly control the condition.