八正散

4. Common modifications

• Bloody stranguria (blood in the urine, stabbing pain on urination): add Xiao Ji (cephalanoplos herb), Bai Mao Gen (imperata rhizome), and Sheng Di (fresh rehmannia root) to cool the blood and stop bleeding.
• Stone stranguria (sand or stones in the urine, difficult and hesitant urination, or interruption of the urine stream): add Jin Qian Cao (lysimachia herb), Hai Jin Sha (lygodium spores), and Ji Nei Jin (chicken gizzard lining) to dissolve and expel stones.
• Unctuous stranguria (turbid urine resembling rice-washing water): add Bi Xie (dioscorea hypoglauca rhizome) and Shi Chang Pu (acorus tatarinowii rhizome) to separate the clear from the turbid.
• Blazing heat toxin, with accompanying fever and bitter taste in the mouth: add Pu Gong Ying (dandelion herb), Jin Yin Hua (honeysuckle flower), and Di Ding (yedoensis viola herb) to strengthen the clearing of heat and resolving of toxin.
• Damp-heat damaging yin, with dry mouth and dry tongue: the dosage of bitter, cold herbs may be reduced somewhat, or Sheng Di and Zhi Mu (anemarrhena rhizome) may be added to nourish yin.

5. Cautions and clinical notes

• Contraindications:
  • Contraindicated in those with Spleen-Stomach cold deficiency and in pregnant women. This formula is intensely bitter and cold, and can easily damage Spleen-Stomach yang qi.
  • Contraindicated for difficult urination due to Kidney deficiency (such as with soreness and weakness of the lower back and knees, and aversion to cold with cold limbs).
  • Use with caution in those of weak constitution.
• This formula treats the branch (symptomatic) aspect; it should be stopped once the disorder resolves and not taken long-term, to avoid damaging the body's righteous qi.
• Drinking plenty of water during administration is advisable, to assist in promoting urination and freeing stranguria. The diet should be bland; spicy, greasy, and irritating foods should be avoided.

6. Granule conversion and dose

• Calculation of the total raw herb weight of the original formula:
  • Qu Mai (dianthus herb) 15 g + Bian Xu (knotweed herb) 15 g + Che Qian Zi (plantago seed) 15 g + Hua Shi (talc) 15 g + Mu Tong (akebia stem) 6 g + Zhi Zi (gardenia fruit) 12 g + Da Huang (rhubarb root and rhizome) 9 g + Deng Xin Cao (juncus pith) 3 g + Zhi Gan Cao (honey-fried licorice root) 6 g = 96 g.
  • (Note: for the sake of safety, modern clinical practice often substitutes "Chuan Mu Tong" or "Tong Cao" for Guan Mu Tong; the dosage may be adjusted slightly as a result.)
• Conversion to 5:1 granules:
  • 96 g raw herb ÷ 5 = 19.2 g of granules.
• Recommended dose:
  • One dose daily, taken in two servings, morning and evening, dissolved in warm water, about 10 g per serving.
  • Because this formula is potent and fast-acting, it must be taken strictly as directed by a physician, who will adjust the dosage and Duration of use according to the severity of the patient's damp-heat and their constitution.