半夏白术天麻汤

3. Tongue and pulse

• Tongue: White, greasy tongue coating.
• Pulse: Wiry, slippery pulse (wiry indicates Liver wind, slippery indicates phlegm-damp).

4. Common modifications

• Marked dizziness with frequent vomiting: Add Dai Zhe Shi (hematite), Zhu Ru (bamboo shavings), and Xuan Fu Hua (inula flower) to heavily settle and direct rebellious qi downward to stop vomiting.
• Phlegm stagnation transforming into heat, with bitter taste in the mouth and yellow, greasy coating: Add Huang Lian (coptis rhizome), Huang Qin (scutellaria root), and Zhu Ru to clear heat and transform phlegm.
• Marked Liver yang rising, with irritability and red face: Add Gou Teng (uncaria stem with hooks), Shi Jue Ming (abalone shell), and Zhi Zi (gardenia fruit) to calm the Liver and subdue yang.
• Predominant dampness, with heavy-headedness as if wrapped and limb fatigue: Add Ze Xie (alisma rhizome) and Zhu Ling (polyporus) to strengthen the effect of draining dampness.

5. Cautions and clinical notes

• Contraindications:
  • Not to be used for dizziness due to yin deficiency with yang hyperactivity, or due to qi and blood deficiency. This presents with dry mouth, tidal fever, red tongue with scanty coating, or pale complexion, palpitations, and fatigue.
  • Use with caution for dizziness and headache due to Liver fire flaring upward. This presents with severe headache, bitter taste and dry throat, constipation, and dark urine.
  • This formula is somewhat warm and drying in nature; for patterns of heat-phlegm, modification is required.
  • Ban Xia (pinellia rhizome) in this formula is toxic and should not be taken in excess or for a prolonged period.

6. Granule conversion and dose

• Calculation of total raw herb weight in the original formula:
  • Ban Xia 9 g + Tian Ma 9 g + Bai Zhu 12 g + Fu Ling (poria) 9 g + Ju Hong (red tangerine peel) 6 g + Sheng Jiang (fresh ginger) 3 g + Da Zao (jujube) 4 g + Zhi Gan Cao (honey-fried licorice root) 4.5 g = 56.5 g.
• Conversion to 5:1 granules:
  • 56.5 g raw herbs ÷ 5 = 11.3 g granules.
• Recommended dose:
  • One dose daily, taken in two portions, morning and evening, dissolved in warm water, about 6 g per dose.
  • Or as directed by a physician, who will modify the formula according to the relative predominance of wind and phlegm and the degree of Spleen deficiency in the patient; the total raw herb weight should be recalculated accordingly after any adjustment.