by Mark W. Frost, MSTCM, L.Ac.
A complex understanding of how the physical environment influences the human body is central to Chinese medical thought and is a hallmark of its’ sophisticated view of health and disease. From the early writings of the I Ching, The Huang Di Nei Jing Su Wen, and the Shang Han Lun, Chinese physicians have been blessed by their understanding of how the body is influenced by the changing of the seasons, and the six environmental factors of wind, cold, heat, dampness, dryness, and summer heat. The doctors of old understood that the negative influences of the environmental factors are counterbalanced by the Zheng or Upright Qi, which is comprised of proper levels of qi, blood, yin and yang, and the balanced functioning of the zang and fu organs. Today’s practitioners of traditional Chinese medicine evaluate these many factors to diagnose the cause and nature of the patient's illness and determine a path to healing.
Of particular note in today's medical environment is the TCM concept of Li Qi, or epidemic Qi. The concept of Li Qi is that there are times when an external environmental influence, outside the six environmental factors, can exert a powerful negative impact on the health of a population, regardless of a population's general health status. Li Qi can negatively affect patients of all ages and produces illness in both the weak and the strong.
The TCM concept of Li Qi was later developed into the more complex concept of Du or toxin. Du/toxin is considered a discreet cause of illness that lies outside of the traditional internal and external causes of disease. Du is categorized as a miscellaneous cause of illness and comprises a wide array of pathogenic influences including but not limited to viruses, bacteria, protozoa, environmental and chemical toxins, and plant toxins. Modern plagues and seasonal epidemics fall under the TCM concepts of both Li Qi and Du/toxin.
At this point in time, as TCM practitioners, we find ourselves in a complex and challenging environment. With an overburdened medical system, lack of easy access for viral testing, and frightened patients presenting with wide variations on typical wind-cold and wind-heat symptoms, it is difficult to know exactly what we can and should do. In this light, we share with you an important herbal formula suitable for treating many mixed picture seasonal wind heat toxin pathologies. This herbal formula comes from Guidance for Corona Virus Disease 2019, National Health Commission of the PRC, and has been used extensively in Chinese hospitals for treatment of initial onset, mixed picture wind heat toxin. It has been tested in current clinical settings and shows significant efficacy in treating a wide range of heat toxin pathologies affecting the respiratory tract. It should be noted that this formula should not be considered a substitute for western medical treatment for moderate to severe upper respiratory illness.
Qing Fei Pai Du Tang: Decoction to Clear the Lung and Eliminate Toxin
- Ma Huang (Esphedra Herb) 9 grams
- Gan Cao (Zhi) (Licorice Root Honey-Coated) 6 grams
- Xing Ren (Ku) (Bitter Apricot Kernel) 9 grams
- Shi Gao (Gypsum) 18 grams decocted first
- Gui Zhi (Cinnamon Twig) 9 grams
- Ze Xie (Alisma / Water Plantain Rhizome) 9 grams
- Zhu Ling (Polyporus Sclerotium) 9 grams
- Bai Zhu (Chao) (White Atractylodes Rhizome - Prepared) 9 grams
- Fu Ling (Poria / Hoelen Sclerotium) 15 grams
- Chai Hu (Bupleurum Root) 16 grams
- Huang Qin (Scutellaria / Skullcap Root) 6 grams
- Ban Xia (Jiang) (Pinellia Rhizome - Gingered) 9 grams
- Zi Wan (Aster Root) 9 grams
- Kuan Dong Hua (Coltsfoot Flower) 9 grams
- She Gan (Belamcanda / Blackberry Rhizome) 9 grams
- Shan Yao (Discorea / Chinese Yam Root) 12 grams
- Zhi Shi (Bitter Orange Fruit) 12 grams
- Chen Pi (Tangerine Peel) 6 grams
- Guang Huo Xiang (Agastache / Patchouli / Pogostemon Herb) 9 grams
- Sheng Jiang (Fresh Ginger) 6 grams
On initial observation this formula may look somewhat confusing and excessive, but actually nothing could be farther from the truth. This brilliant prescription is comprised of four classical herbal decoctions, each one addressing a unique aspect of a complex pathology.
The four formulas that make up Qing Fei Pai Du Tang are:
- Ma Xing Shi Gan Tang
- She Gan Ma Huang Tang
- Wu Ling San
- Xiao Chai Hu Tang
Each of these individual formulas address a unique aspect of the overall mixed picture of this pathological condition. Together they work in a synergistic manner to eliminate toxic pathogenic influences from the lung, the throat, the upper respiratory tract, the Spleen and the Shao Yang region of the body. Because of the unique nature of certain heat toxin pathogens and their ability to lodge in different regions of the body, a complex formula is needed to drive the toxic Qi from these various regions simultaneously.
Ma Xing Shi Gan Tang
- Ma Huang: 9 grams
- Xing Ren (Ku): 9 grams
- Shi Gao: 15-30 grams
- Gan Cao (Zhi): 6 grams
This classical formula from the Shang Han Lun is used here to address excess heat or fire attacking the lungs. Symptoms may include fever, thirst, wheezing, coughing, labored breathing, and nasal flaring, with a rapid pulse and a thin white or yellow tongue coating. This formula specifically addresses excess heat lodged in the Lung obstructing the smooth flow of Lung qi. The effects of the formula are twofold: to clear excess heat, and to free the Lung qi to assist it in descending properly. Ma Huang's spicy and warm nature alleviates Lung qi constraint, expands the chest, eliminates wheezing, and descends the Lung qi. Shi Gao drains heat and fire from the Lung, moderates the strong diaphoretic effect of Ma Huang, and clears heat from the Stomach and the muscles to reduce fever and excess perspiration. Ku Xing Ren descends the Lung qi and stops cough and wheezing with its downward qi directing nature. Zhi Gan Cao moistens the Lungs, reduces inflammation, assists in stopping cough, gently nourishes the Qi, and harmonizes the prescription. This formula is considered especially useful in addressing both wheezing and labored breathing due to toxic heat in the Lung. Modern research on Ma Xing Shi Gan Tang has demonstrated that the formula blocks viral entry phase mechanisms, inhibits viral replication, and inhibits viral RNA and protein synthesis in human influenza virus and H1N1 strains.
She Gan Ma Huang Tang
- She Gan: 9 grams
- Ma Huang: 9 grams
- Zi Wan: 9 grams
- Kuan Dong Hua: 9 grams
- Ban Xia (Jiang): 9 grams
- Sheng Jiang: 9 grams
She Gan Ma Huang Tang is a modification of Xiao Qing Long Tang. The special place that Xiao Qing Long Tang holds within the TCM formulary is its’ ability to release wind-cold from the exterior while also transforming thin mucus in the interior. She Gan Ma Huang Tang differs from Xiao Qing Long Tang in that it addresses more pronounced cough and wheezing and eliminates rattling phlegm in the chest. In Qing Fei Pai Du Tang, Xi Xin, Wu Wei Zi, and Da Zao have been removed from the original formula. Overall, She Gan Ma Huang Tang increases the larger formula's ability to suppress cough, descend the Lung qi, and eliminate phlegm in the Lung. She Gan's strong cold and bitter nature increases the formula's ability to eliminate the symptoms of a sore and inflamed throat and exerts a strong anti-inflammatory effect on the mucosal lining of the bronchioles and lung tissue. This formula is presently used in China for the treatment of bronchial asthma and is currently undergoing clinical efficacy studies.
Xiao Chai Hu Tang
- Chai Hu: 16 grams
- Huang Qin: 6 grams
- Ban Xia (Jiang): 9 grams
- Sheng Jiang: 9 grams
- Gan Cao (Zhi): 6 grams
This extraordinarily unique formula was developed to open and clear constraint in the Shao Yang region of the body, considered midway between the surface and the interior. This is done through harmonization. Chai Hu, the chief herb, is the supreme herb for clearing pathogenic factors in the Shao Yang. Chai Hu frees constraint of the Liver Qi, allowing it to spread and ascend, thus helping the Liver to maintain the free flow of Qi throughout the body as it is the master Qi regulating organ. The deputy, Huang Qin, drains heat and stagnation from the Liver and Gall Bladder, and assists in venting pathogenic influences in this region. Jiang Ban Xia and Sheng Jiang warm and transform phlegm and turbidity, harmonize the middle burner, descent rebellious Qi, stop nausea and vomiting, and benefit appetite and digestion. Zhi Gan Cao harmonizes the formula, and gently nourishes the Qi of the Spleen and Lung. In Qing Fei Pai Du Tang, Ren Shen and Da Zao are removed to prevent possible reinforcement of the external pathogen’s strength.
In the context of Qing Fei Pai Du Tang, Xiao Chai Hu Tang addresses the symptoms of irritability and restlessness, chest fullness, difficulty in taking deep breaths, nausea and vomiting, low and downcast mood, and lack of appetite due to Liver and Stomach disharmony.
This formula is singularly useful in certain types of Li Qi pathologies where the pathogen enters many regions of the body simultaneously. When pathogens lodge in the Shao Yang, clinical diagnosis of this fact is often difficult, and without proper clearing of the Shao Yang, illnesses linger and can lead to prolonged waxing and waning of the condition.
Wu Ling San
- Ze Xie: 9 grams
- Fu Ling: 15 grams
- Bai Zhu: 9 grams
- Gui Zhi: 9 grams
As unusual as it may seem, Wu Ling San is a vital component of Qing Fei Pai Du Tang’s efficacy. Wu Ling San's special place in the TCM formulary lies in its ability to treat fluid buildup in the interior due to a pathogen causing stagnation on the exterior. Symptoms appropriate to our discussion include headache, fever, irritability, edema, vomiting and diarrhea due to sudden turmoil disorder, heaviness, shortness of breath and coughing.
As the chief herb, Ze Xie dredges the water pathways in the lower burner, leaches dampness and promotes urination. Being cold in nature, Ze Xie eliminates constrained heat caused by fluid stagnation and phlegm buildup. It is the strongest diuretic herb in the formula. Fu Ling and Bai Zhu work together to strengthen the Spleen and promote urination, with Fu Ling being especially effective in leaching out dampness throughout the body. Gui Zhi's warm and spicy nature, having the ability to vitalize the blood, excels at opening the channels and collaterals both on the exterior and in the interior.
The many factors that contribute to excess fluid stagnation in this clinical context include an external pathogen causing stagnation on the surface and impairing the descending function of the Lung, restraint of the Liver qi's regulation of the Qi dynamic, suppression of the Spleen's role in regulating fluids due to taxation of the Spleen Qi in countering an external pathogen, phlegm stagnation in the upper burner, and subsequent accumulation of heat. Thus, within Qing Fei Pai Du Tang, Wu Ling San is critical in addressing fluid congestion throughout the body, particularly in the lung.
The Four Orphans
- Shan Yao: 12 grams
- Guang Huo Xiang: 9 grams
- Chen Pi: 6 grams
- Zhi Shi: 6 grams
The four remaining herbs in Qing Fei Pai Du Tang are all tied together by their shared ability to assist the functioning of the Spleen. Shan Yao tonifies the Spleen, Kidney and Lung without the risk of strengthening the external pathogen. Aromatic Huo Xiang gently dries the Spleen, increases appetite and comforts the middle jiao. Chen Pi and Zhi Shi together regulate and descend the Stomach Qi, dispel stagnation and bloating, and facilitate the proper descending function of both the Lung and Stomach.
Qing Fei Pai Du Tang
Synopsis of the pathological progression indicating Qing Fei Pai Du Tang:
- External invasion of wind heat toxin with minimal lingering symptoms on the exterior.
- Penetration of the heat toxin past the surface and entering the upper respiratory tract, the throat and the lung.
- Penetration of the heat toxin into the Shao Yang region.
- Possible fluid and phlegm retention in the lung. Stagnation and disruption of both the Lung and Spleen's role in proper fluid metabolism.
- Disruption of the functioning of the Spleen and Stomach, with low appetite, bloating, fullness, and distention.
Treatment Principle for Qing Fei Pai Du Tang
- Release the surface and dispel wind heat
- Open and descend the Lung Qi
- Clear heat toxin from the Lung and channel system
- Open and rectify the Shao Yang
- Drain phlegm and fluid accumulation in the Lung
- Benefit Spleen and drain dampness, gently descend the Stomach qi
Preparation Instructions and Dosage
Place herbs in a cooking pot, preferably enamel or stainless steel, add water to rinse thoroughly, and pour off rinse water. Add enough water again to completely cover the herbs in the pot and bring to a gentle boil. Cook herbal mixture until approximately one- and one-half cup of liquid remains. This should take approximately one hour, more or less. Decant the tea through a strainer into a separate container. Administer approximately one-half cup of tea three times daily, between meals. The herb tea is best taken warm.
As with every treatment, necessary modification of the herbal formula content and individual herb dosage may be required to precisely balance the formula to the presentation of the patient. A careful application of tongue and pulse diagnosis is essential in this process and should not be overlooked. Appropriate attention to the individual patient’s constitution and health history should also be taken into consideration when prescribing this herbal formula. Special caution should be given to pregnant and nursing mothers. Finally, daily communication with the patient is highly recommended and necessary in evaluating treatment success and illness progression or resolution. Do not hesitate to refer patient to primary or emergency care if patient presentation warrants.
“A physician needs to possess a moral conscience, ethical conduct and a compassionate attitude toward those in need of attention. In all interactions with patients, the physician is always composed, takes the necessary time, remains objective, and performs every procedure with the utmost care and precision.” -Huang Di Nei Jing Su Wen
Mark W. Frost, MSTCM, L.Ac. Chair, Herbal Medicine Department American College of Traditional Chinese Medicine San Francisco, CA