固冲汤

4. Common modifications

• Cold limbs with sweating, yang qi about to collapse: urgently use Du Shen Tang (Ginseng Decoction, with large-dose ginseng) decocted and taken to swallow the formula, or add Fu Zi (prepared aconite root) to recover yang and stem collapse.
• Bright red bleeding with signs of heat: add Sheng Di (fresh rehmannia root) and Di Yu (sanguisorba root) to cool the blood and stop bleeding.
• Palpitations and insomnia: add Suan Zao Ren (spine date seed) and Yuan Zhi (polygala root) to nourish the heart and calm the spirit.

5. Cautions and clinical notes

• Contraindications:
  • Not to be used for flooding and spotting due to reckless movement of blood caused by heat. Manifesting as deep red bleeding, thirst, and a red tongue with yellow coating.
  • Use with caution for flooding and spotting due to internal blood stasis. Manifesting as bleeding with much clotting and abdominal pain that resists pressure.

6. Granule conversion and dose

• Calculation of the total weight of raw herbs in the original formula:
  • Bai Zhu (white atractylodes rhizome) 30 g + Huang Qi (astragalus root) 18 g + calcined Long Gu (dragon bone) 24 g + calcined Mu Li (oyster shell) 24 g + Shan Zhu Yu (asiatic cornelian cherry fruit) 24 g + Bai Shao (white peony root) 12 g + Hai Piao Xiao (cuttlebone) 12 g + Qian Cao (rubia root) 9 g + charred Zong Lu (palm fiber) 6 g + Wu Bei Zi (Chinese gall) 1.5 g = 160.5 g.
• Conversion to 5:1 granules:
  • 160.5 g of raw herbs ÷ 5 = 32.1 g of granules.
• Recommended dose:
  • One dose daily, taken in two portions, morning and evening, dissolved in warm water, about 16 g per dose.
  • Or as directed by a physician. Flooding and spotting is an emergency condition; use must be under a physician's guidance, who will manage the bleeding urgently and adjust the formula according to the patient's condition and constitution.