半夏泻心汤

3. Tongue and pulse

• Tongue: Pale red or somewhat red tongue body, with a greasy coating that is yellow and white intermingled (sometimes described as "a greasy coating overlaid with yellow").
• Pulse: Wiry, slippery, and rapid pulse, or soft (ru) and rapid pulse.

4. Common modifications

• Marked fullness and blockage with pronounced qi stagnation: add Zhi Shi (immature bitter orange) and Hou Po (magnolia bark) to strengthen the action of moving qi and dissipating pi.
• Internal retention of water-damp with difficult urination and edema: add Fu Ling (poria), Zhu Ling (polyporus), and Ze Xie (alisma) to disinhibit water and drain dampness.
• Undigested food accumulation with belching of rotten odor and sour regurgitation: add Shen Qu (medicated leaven), Shan Zha (hawthorn fruit), and Mai Ya (barley sprout) to dissolve food accumulation and guide it downward.
• Predominant Stomach heat with bitter taste and dry mouth: the dosage of Huang Lian (coptis rhizome) may be increased.
• Predominant middle cold with cold pain in the abdomen: the dosage of Gan Jiang (dried ginger) may be increased, or Fu Zi (aconite) may be added.
• Derived formulas:
  • Sheng Jiang Xie Xin Tang (Fresh Ginger and Coptis Combination): reduce the amount of Gan Jiang and add Sheng Jiang (fresh ginger). Used for pi syndrome due to intermingled water and heat, with symptoms such as dry belching with the odor of food and water qi below the ribs.
  • Gan Cao Xie Xin Tang (Licorice and Coptis Combination): increase the dosage of Zhi Gan Cao (honey-fried licorice root). Used for pi syndrome due to marked Stomach qi deficiency, with symptoms such as diarrhea occurring several dozen times a day, undigested food in the stool, dry retching, and vexation.

5. Cautions

• Contraindications:
  • Not suitable for epigastric fullness and blockage caused purely by excess heat or purely by deficiency cold.
  • Not suitable for excess-type pi (hard and painful on palpation) due to qi stagnation with internal food accumulation.
  • Since Ban Xia (pinellia rhizome) in the formula is toxic, it should not be taken in excess or over a long period.

6. Granule conversion and dose

• Calculation of the total raw herb weight of the original formula:
  • Ban Xia 12 g + Gan Jiang (dried ginger) 9 g + Huang Qin (scutellaria root) 9 g + Huang Lian (coptis rhizome) 3 g + Ren Shen (ginseng) 9 g + Da Zao (jujube) 4 pieces (about 6 g) + Zhi Gan Cao (honey-fried licorice root) 9 g = 57 g.
  • (Note: In clinical practice, Dang Shen (codonopsis root) is often substituted for Ren Shen, and the dosage may be increased to 15 g, with the total raw herb weight changing accordingly.)
• Conversion to 5:1 granules:
  • 57 g raw herbs ÷ 5 = 11.4 g granules.
• Recommended dose:
  • One dose per day, taken in 2 divided doses morning and evening, dissolved in warm water, about 6 g per dose.
  • Or as directed by a practitioner, who will make fine adjustments according to the patient's relative predominance of cold, heat, deficiency, and excess; the total raw herb weight should then be recalculated according to the adjusted formula.