百合固金汤

2. Pattern and presentation (core indicators)

• Principal symptoms:
  1. Cough and wheezing: Dry cough or scanty phlegm, phlegm that is sticky and difficult to expectorate, or streaked with blood.
  2. Dry and sore throat: Dryness and pain in the throat, hoarseness of voice.
  3. Blood-streaked phlegm: Deficiency fire scorching the Lung network, leading to coughing of blood or nosebleed.
• Systemic and accompanying symptoms:
  • Bone-steaming tidal fever (fever that comes and goes like the tide, at fixed times), heat in the palms and soles.
  • Night sweats, insomnia.
  • Dizziness and blurred vision, aching and weak lower back and knees (signs of Kidney yin deficiency).

3. Tongue and pulse

• Tongue appearance: Red tongue with scanty coating, or a patchy, peeling coating; the pulse is thin and rapid.

4. Common modifications

• For more pronounced coughing of blood or nosebleed: Jie Geng, which has an upward-lifting action, may be removed, and Bai Mao Gen (imperata rhizome), Ce Bai Ye (biota leaf) and Xian He Cao (agrimony) added to cool the blood and stop bleeding.
• For unrestrained Lung qi with cough that persists for a long time: Add Wu Wei Zi (schisandra fruit) and He Zi (chebule fruit) to astringe the Lung and stop cough.
• For pronounced deficiency fire with marked tidal fever and night sweats: Add Di Gu Pi (lycium root bark) and Bai Wei (cynanchum root) to clear deficiency heat and relieve bone-steaming fever.
• For accompanying qi deficiency with shortness of breath and fatigue: Xi Yang Shen (American ginseng) and Shan Yao (Chinese yam) may be added to tonify both qi and yin.

5. Cautions and clinical notes

• Contraindications:
  • Use with caution in those with Spleen-Stomach cold from deficiency. Most herbs in this formula are sweet, cold and cloying, and can easily hinder Spleen-Stomach transportation and transformation, leading to abdominal distension and fullness, reduced appetite and loose stools.
  • Not to be used for cough due to external contraction of wind-cold or exuberant phlegm-damp. Such cough presents with a heavy cough sound, thin white phlegm, nasal congestion and clear nasal discharge.
  • While taking this formula, avoid spicy, greasy and fried foods, so as not to promote fire and generate heat.

6. Granule conversion and dose

• Calculation of the total raw herb weight of the original formula:
  • Bai He 12 g + Sheng Di Huang 9 g + Shu Di Huang 9 g + Mai Dong 9 g + Xuan Shen 6 g + Dang Gui 9 g + Bai Shao 6 g + Bei Mu 6 g + Jie Geng 6 g + Sheng Gan Cao 3 g = 75 g.
• Conversion to 5:1 granules:
  • 75 g raw herbs ÷ 5 = 15 g granules.
• Suggested dose:
  • One dose per day, taken in two portions, morning and evening, dissolved in warm water, about 8 g per dose.
  • Or as directed by the practitioner, who will adjust the formula according to the relative emphasis of yin deficiency and fire excess in the patient, in which case the total raw herb weight must be recalculated according to the adjusted formula.