Zhi Sou San He Xiao Chai Hu Tang Jia Jian

This is a research formula from the People’s Republic of China created by Yuan Xin-shun of the Xin Xiang Municipal Cement Factory Workers Hospital in Henan. It is a combination of Zhi Sou San (Stop Coughing Powder) and Xiao Chai Hu Tang (Minor Bupleurum Decoction) with additions and subtractions. Our version is a 9:1 extract.

RX
Chai Hu (Radix Bupleuri)
Zi Wan (Radix Asteris)
Bai Qian (Rhizoma Cynanchi Stantonii)
Bai Bu (Radix Stemonae)
Dang Shen (Radix Codonopsitis)
Jie Geng (Radix Platycodi)
Sang Bai Pi (Cortex Mori)
Fu Ling (Poria)
Da Zao (Fructus Jujubae)
Ban Xia (Rhizoma Pinelliae)
Chen Pi (Pericarpium Citri Reticulatae)
Huang Qin (Radix Scutellariae)
Zi Su Ye (Fructus Perillae)
Sheng Jiang (uncooked Rhizoma Zingiberis)
Gan Cao (Radix Glycyrrhizae)

INDICATIONS:

This formula is for the treatment of chronic cough and chronic panting and wheezing manifesting as phlegm heat with either an underlying liver-spleen disharmony or a shao yang aspect pattern.

THE SIGNS AND SYMPTOMS OF PHLEGM HEAT INCLUDE:

• Coughing and panting

• Thick, yellow phlegm

• A slippery, rapid pulse

THE SIGNS AND SYMPTOMS OF LIVER DEPRESSION QI STAGNATION INCLUDE:

• Irritability

• Chest oppression

• Rib-side distention

• A bowstring pulse

THE SIGNS AND SYMPTOMS OF SPLEEN VACUITY INCLUDE:

• Fatigue

• Poor appetite

• A tendency to loose stools

• A fat tongue with teeth-marks on its edges

THE SIGNS AND SYMPTOMS OF A SHAO YANG ASPECT DISEASE INCLUDE:

• Alternating fever and chills

• Poor appetite

• 41

• A bitter taste in the mouth

• Dry throat

• White and yellow tongue fur

• A bowstring pulse

COMBINATIONS:

If phlegm dampness is more pronounced, this formula can be combined with Er Chen Wan (Two Aged [Ingredients] Pills). If spleen vacuity is more marked, it may be combined with Liu Jun Zi Wan (Six Gentlemen Pills). If there is concomitant qi vacuity with a defensive qi insecurity and spontaneous perspiration, this formula may be combined with Yu Ping Feng San Wan (Jade Windscreen Powder Pills). If enduring heat has damaged yin fluids, this formula may be combined with Sha Shen Mai Men Dong Tang Wan (Glehnia & Ophiopogon Decoction Pills) or Bai He Gu Jin Wan (Lily Secure Metal Pills) as appropriate. If enduring phlegm congestion and nondepuration of the lung qi have resulted in concomitant blood stasis, this formula can be combined with Xue Fu Zhu Yu Tang Wan (Blood Mansion Dispel Stasis Decoction Pills).

FORMULA EXPLANATION:

If, due to either external contraction or internal damage, the lungs lose their depuration and downbearing, the lung qi will not clear and the qi mechanism will become inhibited. If the lung qi becomes inhibited, phlegm fluids will typically be engendered, in which case there will be coughing with profuse phlegm. If phlegm fluids cause depression that transforms heat or becomes mixed with depressive heat floating upward from the liver and stomach, phlegm dampness will become phlegm heat. The tendency to engender phlegm is all the greater if there is an underlying spleen qi vacuity. In this case, the spleen qi is too vacuous and weak to move and transform water fluids. These collect and transform into dampness. If dampness lingers and endures, it will congeal into phlegm. Thus it is said, “The spleen is the root of phlegm engenderment; the lungs are the place where phlegm is stored.” Further, because the liver and lungs have a reciprocal relationship in terms of the flow of qi, if the lungs lose their depuration and downbearing, liver depression will be aggravated. Conversely, if there is liver depression, it makes it even harder for the lungs to recuperate. Therefore, this formula not only clears heat and transforms phlegm, stops cough and levels panting, but also harmonizes the liver and spleen.

Within this formula, Zi Wan, Bai Qian, Bai Bu, Ban Xia, Sheng Jiang, and Chen Pi rectify the qi, transform phlegm, and stop cough. Zi Wan, Ban Xia, and Bai Qian are an important combination for coughing and wheezing associated with profuse, difficult to expectorate phlegm. Jie Geng loosens the chest, diffuses the lungs, and transforms phlegm. It also acts to guide the other medicinals to the lungs and chest. Gan Cao and Jie Geng together are able to clear and disinhibit the throat. Zi Su Ye and Sang Bai Pi clear the lungs, stop coughing, and level panting. Fu Ling aids Ban Xia, Chen Pi, and Sheng Jiang eliminate dampness and transform phlegm. Huang Qin clears the lungs, while Dang Shen and Da Zao fortify the spleen and support the righteous. Chai Hu rectifies the qi and disinhibits the qi mechanism of all three burners.
In a study published on page 89 in issue #2, 2003 of the An Hui Zhong Yi Lin Chuang Za Zhi (Anhui Journal of Clinical Chinese Medicine), this formula achieved a 76.5% cure rate and a 94.9% total effectiveness rate in a group of 98 patients with chronic cough and asthma.

My patient does have signs and symptoms of:
Phlegm heat Yes No
Spleen vacuity Yes No
Liver depression Yes No
Shao yang aspect disease (not necessary) Yes No