瓜蒌薤白半夏汤

o Cough with copious phlegm, shortness of breath.

o Turbid, greasy tongue coating, or white and slippery coating.

3. Tongue and pulse

• Tongue: Pale tongue body, with white greasy or slippery greasy coating.
• Pulse: Deep and wiry, or tight.

4. Common modifications

• Phlegm-turbidity stagnating and transforming into heat, with yellow phlegm and yellow greasy coating: Add Huang Lian (coptis rhizome), in the sense of combining with Xiao Xian Xiong Tang (Minor Chest-Draining Decoction), to clear heat and transform phlegm.
• Marked blood stasis, with pain like needle pricks: Add Dan Shen (salvia root), Chuan Xiong (chuanxiong rhizome), Tao Ren (peach kernel), and Hong Hua (safflower) to invigorate blood and dispel stasis.
• Severe qi stagnation with distension and oppression: Add Zhi Shi (immature bitter orange) and Hou Po (magnolia bark) to move qi and relieve distension.
• Concurrent qi deficiency, with shortness of breath and fatigue: Add Dang Shen (codonopsis root) and Huang Qi (astragalus root) to boost qi and support the correct qi.

5. Cautions and clinical notes

• Contraindications:

o This formula is warm and drying in nature; it is contraindicated in patients with yin deficiency consumptive lung disease or lung dryness with coughing of blood.

o In patients with weak stomach qi, the combined use of Gua Lou (trichosanthes fruit) and Ban Xia (pinellia rhizome) in this formula may readily cause nausea and vomiting; caution is advised.

o Ban Xia in this formula is toxic and should not be taken in excess or over a prolonged period.

6. Granule conversion and dose

• Calculation of the total crude herb weight of the original formula (excluding white wine):

o Whole Gua Lou 24 g + Xie Bai (chinese chive bulb) 9 g + Ban Xia 12 g = 45 g.

• Conversion to 5:1 granules:

o 45 g crude herb ÷ 5 = 9 g granules.

• Recommended dose and method of administration:

o One dose daily, taken in two portions morning and evening dissolved in warm water, about 4.5 g per dose.

o Or as directed by a physician, who will add or subtract herbs according to the severity of the patient's phlegm-turbidity and the presence of concurrent blood stasis or qi stagnation; in that case the total crude herb weight must be recalculated according to the adjusted formula.

o Regarding white wine: The original formula was decocted with white wine, intended to help the medicinal force ascend. In modern usage, if the condition requires it, a physician may direct that the granules be taken with a small amount of yellow wine as a guide, in imitation of the ancient method. This must strictly follow the physician's instructions and should not be added on one's own.