半夏厚朴汤

4. Common modifications

• For marked qi stagnation, with rib-side distension and pain and pronounced emotional depression: add Chai Hu (bupleurum root), Yu Jin (turmeric root tuber), and Xiang Fu (cyperus rhizome) to strengthen the effect of resolving Liver qi stagnation.
• For phlegm stagnation transforming into heat, with sore throat, agitation, and a reddish tongue: add Gua Lou (trichosanthes fruit), Zhu Ru (bamboo shavings), and Huang Qin (scutellaria root) to clear heat and transform phlegm.
• For pronounced dryness of the throat where yin damage is not severe: Xuan Shen (scrophularia root) and Mai Dong (ophiopogon tuber) may be added, but their rich, cloying nature should be noted, as it may hinder the pathogen.
• For pain in the hypochondrium and epigastrium: add Chuan Lian Zi (toosendan fruit) and Yan Hu Suo (corydalis rhizome) to move qi, invigorate blood, and relieve pain.
• Modern applications: This formula is widely used for hysteria, gastric neurosis, chronic pharyngitis, cough, and reflux esophagitis where the pattern is one of bound phlegm and qi.

5. Cautions and clinical notes

• Contraindications:
  • Not to be used in cases of yin deficiency with scanty fluids or effulgent fire, presenting with dry throat and mouth, a red tongue with scanty coating, and vexation with heat in the five centers (palms, soles, chest). This is because most herbs in this formula are pungent, warm, bitter, and drying, and may readily damage yin fluids.
  • Use with caution when qi stagnation has transformed into fire.
  • Ban Xia in this formula is toxic; it should not be taken in excess or over a prolonged period.
  • The patient should maintain a relaxed and settled mood during treatment.

6. Granule conversion and dose

• Calculation of total raw herb weight in the original formula:
  • Ban Xia (pinellia rhizome) 12 g + Hou Pu (magnolia bark) 9 g + Fu Ling (poria) 12 g + Sheng Jiang (fresh ginger) 15 g + Zi Su Ye (perilla leaf) 6 g = 54 g.
• Conversion to 5:1 granules:
  • 54 g raw herb ÷ 5 = 10.8 g granules.
• Recommended 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, who will adjust the formula according to the relative predominance of qi stagnation and phlegm obstruction in the patient; the total raw herb weight should be reconverted accordingly after any adjustment.