By Eric Brand

One of the interesting things about studying Chinese medicine is the diversity of perspectives that one finds. In an earlier blog, I mentioned that the nature of Zhi Shi is fundamentally inconsistent across different authoritative Chinese source texts. Some texts state that it is cool or cold, others state that it is warm. In fact, there are many formulas and single medicinals that are described differently in different texts.

With single medicinals, the primary material that commonly varies from text to text includes:

1) The breakdown of the categories and subcategories themselves
2) The placement of medicinals within these categories
3) Channel entry and to a lesser extent, nature and flavor
4) Dosage

With formulas, the main differences lie in how different books classify the formulas (i.e., which chapter they are found in), and how the ingredients break down in terms of medicinal roles. Many formulas were written before the theory of medicinal roles developed, so later scholars that attempt to break down the roles (sovereign, minister, etc.) often disagree.

Follow up:

Chuan Xiong Cha Tiao San is a perfect example of this. Sometimes it is put in the wind chapter, sometimes in the exterior-resolving chapter. Some sources consider it better for heat and others consider it more suitable for cold. Regardless, it is a relatively balanced formula that is extremely effective for headache due to external contraction of wind.

This formula came from one of the first Imperial formula collections, the Tai Ping Hui Min He Ji Ju Fang, and remains in common use today. See the commentary below to read the debate on its nature and medicinal roles.

Chuan Xiong Cha Tiao San (川芎茶调散 Tea-Blended Chuanxiong Powder)

Source: Tai Ping Hui Min He Ji Ju Fang (Tai-Ping Imperial Grace Pharmacy Formulas).

Ingredients
Bo he (薄荷 mint, Menthae Herba) (never sees fire) 8 liang/240 g.
Chuan xiong (川芎 chuanxiong, Chuanxiong Rhizoma) 4 liang/120 g.
Jing jie (荆芥 schizonepeta, Schizonepetae Herba) (stem removed) 4 liang/120 g.
Xi xin (细辛 asarum, Asari Herba)(remove skin and tips) (neck removed) 1 liang/30 g.
Fang feng (防风 saposhnikovia, Saposhnikoviae Radix) (neck removed) 1.5 liang/45 g.
Bai zhi (白芷 Dahurian angelica, Angelicae Dahuricae Radix) 2 liang/60 g.
Qiang huo (羌活 notopterygium, Notopterygii Rhizoma et Radix) 2 liang/60 g.
Zhi gan cao (炙甘草mix-fried licorice, Glycyrrhizae Radix cum Liquido Fricta) 2
liang/60 g.

Original Method: Grind the above ingredients to a fine powder. Take 2 qian (6 g) per dose after meals with tea. The modern method is to take two 6-gram doses daily with tea, though it can also be made into a decoction if the dosage for making a large batch of powder is reduced.

Actions: Courses wind and relieves pain.

Indications: Externally contracted wind evil with headache. There may also be neck pain, dizziness, and nasal congestion, or aversion to wind with heat effusion. Tongue: thin and white. Pulse: floating.

Warning: Headache can have many causes, both external or internal. This formula is not suitable for headache due to qi vacuity or blood vacuity, as well as liver-kidney yin vacuity with ascendant hyperactivity of liver yang or internal stirring of liver wind.

Discussion

There is some debate as to the medicinal roles in this formula. Some practitioners emphasize the preponderance of warm, acrid wind-coursing medicinals and state that the formula is best for wind-cold headache. Reflecting this view, the formula books of the official Chinese curriculum from 1974–1979 stated that chuan xiong (Chuanxiong Rhizoma), bai zhi (Angelicae Dahuricae Radix), and qiang huo (Notopterygii Rhizoma et Radix) were the sovereign medicinals. These medicinals course wind and relieve pain. Chuan xiong treats lesser yang and reverting yin headache; qiang huo treats greater yang headache; bai zhi treats yang brightness headache.

Others take the view that the large doses of bo he (Menthae Herba) used in the source text indicate that the formula is best for wind-heat headache, and bo he is the sovereign. This is also supported by the fact that the formula is taken with tea, which is bitter and cold. In the words of Wang Ang, a 17th century commentator, the tea “upbears and dissipates wind-heat”; Wang also states that “bo he and jing jie disperse wind-heat, clear and disinhibit the head and eyes, and are therefore the sovereigns; they move upward to raise clear yang and dissipate depressed fire…tea can rise to clear the head and eyes.”

The different perspectives on sovereigns and ministers can be attributed to a different emphasis on whether the formula primarily relieves pain or primarily resolves the exterior. However, there seems to be common agreement that gan cao and tea are both assistants and couriers. Gan cao harmonizes the other medicinals, while tea’s bitter, cold, and downbearing nature clears the upper body. This controls the warm, drying, upbearing and dissipating nature of the other medicinals, so that within the upbearing there is also downbearing.

This formula differs from most exterior-resolving formulas in that it emphasizes medicinals that dispel wind and relieve pain. It treats wind evil when headache is the primary symptom; although typical signs of an exterior pattern can be seen, the formula is not a typical exterior-resolving formula.

According to one traditional source, the powder was to be taken with cong bai (Allii Fistulosi Bulbus) and green tea; the juice from the cong bai was applied to the point tai yang to eliminate severe pain. Ground po xiao (朴硝 impure mirabilite, Natrii Sulfas Non-Purus) was also used by insufflating it into the nose. For left-sided headache, insufflate into the right side, for left-sided headache, insufflate into the left side.

The addition of jiang can (Bombyx Batryticatus) and ju hua (Chrysanthemi Flos) to the base formula creates the formula ju hua cha tiao san (Tea-Blended Chrysanthemum Powder). These additions control the warm dry nature of the acrid-warm substances, and the new formula is especially suitable for dissipating wind-heat and clearing the head and eyes.