New Uses of Huo Xiang Zheng Qi San, Or, If the Pattern Fits, Try It

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

Huo Xiang Zheng Qi San (Agastaches Correct the Qi Powder) is one of the standard 70 formulas all students at Chinese medical schools must learn by heart in their formulas and prescriptions class (fang ji xue). In Chinese Herbal Medicine: Formulas & Strategies (Eastland Press, Seattle), Bensky and Barolet categorize this formulas as a dampness-dispelling formula. It is commonly subcategorized as a formula which transforms dampness and harmonizes the stomach. However, because its functions are that it resolves the exterior and transforms dampness, rectifies the qi and harmonizes the middle, it is often used for the treatment of external wind cold contractions complicated by dampness and turbidity. Therefore, it is commonly prescribed for summertime colds accompanied by fever and chills, nausea, possible vomiting, and non-crisp defecation or diarrhea. Hence, many, if not most, Chinese medical practitioners think of this formula primarily as a treatment for exterior patterns and indigestion. However, it may also be used for more serious internal diseases.

In "The Suitable Use of Huo Xiang Zheng Qi San in Three Cases" appearing in Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), #3, 2000, p. 138, Tu Xue-chun describes his use of this formula in three cases of diseases not usually associated with this formula. These include coronary heart disease, chemotherapy syndrome, and night sweats. These three cases are a good example of "off-label" uses of Chinese medicinal formulas. In standard professional Chinese medicine, treatment is primarily based on the patient’s personal pattern discrimination, not on their disease diagnosis. Therefore, the prescription of a particular formula depends more on the patient’s signs and symptoms, tongue, and pulse than on the published indications of the formula. In fact, a common genre of article in Chinese medical journals is the "New Uses of (this or that) Formula." Unfortunately, many practitioners of Chinese medicine, both Asian and Western, forget this fact – treatment is predicated primarily on pattern discrimination, not on disease diagnosis. Therefore, writers such as Tu Xue-chun are constantly reminding their readers of this fact by presenting such case histories as summarized below.

1. Coronary heart disease

The patient was a 70 year old female who was first examined on Mar. 25, 1999. The patient had had a history of coronary heart disease for 10 years. She commonly had chest oppression, chest pain, and taxation fatigue which were easily provoked or worsened by changes in the weather. During the last 20 days, the woman had experienced chest oppression and a sensation of precordial pressure accompanied by insidious pain. Electrocardiogram showed sinus arrhythmia and an ST-T alteration. Her Western medical diagnosis was coronary heart disease and angina pain. She was administered Xin Xue Kang (Heart Blood Health), Xiao Xin Tong (Disperse Heart Pain), and asperin which gradually resolved her symptoms. However, the day before, her chest oppression and precordial aching and pain recurred. The woman self-administered two pills of She Xiang Bao Xin Wan (Musck Protect the Heart Pills), after which the chest pain relaxed. However, she still had a sensation of chest oppression accompanied by dizziness, nausea, a slimy mouth, torpid intake, loose stools, lack of strength, and lack of warmth in the four limbs. In addition, her tongue was dark with slimy, white fur, while her pulse was fine.

Based on these signs and symptoms, this woman’s Chinese medical pattern was discriminated as cold dampness stagnating in the center and inhibiting the qi mechanism, thus resulting in chest impediment. The treatment principles were to warm, free the flow, and transform dampness and rectify the qi. For these purposes, Huo Xiang Zheng Qi San Jia Jian (Agastaches Correct the Qi Powder with Additions & Subtractions) was chosen. This consisted of: Herba Agastachis Seu Pogostemi (Huo Xiang), Caulis Perillae Frutescentis (Su Geng), Fructus Perillae Frutescentis (Su Zi), Pericarpium Citri Reticulatae (Chen Pi), processed Rhizoma Pinelliae Ternatae (Ban Xia), Radix Platycodi Grandiflori (Jie Geng), Bulbus Allii Fistulosi (Cong Bai), and Pericarpium Trichosanthis Kirlowii (Gua Lou Pi), 10g each, processed Cortex Magnoliae Officinalis (Hou Po), 6g, and mix-fried Radix Glycyrrhizae (Gan Cao), 5g. One ji was administered warm per day in two divided doses after having been decocted in water.

After five ji, the patient’s chest oppression, dizziness, and lack of strength had all remitted. Therefore, 30 grams of Radix Salviae Miltiorrhizae (Dan Shen) and 10 grams of Radix Ligustici Wallichii (Chuan Xiong) were added to the original formula. After taking another 30 ji of these medicinals, her angina pain had completely disappeared and her EKG had returned to normal.

2. Chemotherapy syndrome

The patient was a 56 year old male who was first examined on July 15, 1998. The patient had had surgery for stomach cancer, after which he had been treated with the following chemotherapeutic agents: 5-Fu, MMC, and Ara-C. However, this medications caused nausea and vomiting of anything he put in his stomach. Therefore, each day he vomited a minimum of three times. This was accompanied by dizziness and vertigo, lassitude of the spirit, lack of strength, weak voice, and a sallow yellow facial complexion with black macules. He had no taste for food and there was a bitter taste and sliminess within his mouth. In addition, his stools were loose and not crisp, his tongue was pale with teeth-marks on its edges, there was thick, white, slimy fur, and his pulse was bowstring and fine. The man’s Western medical diagnosis was chemotherapy syndrome. Due to his weakened bodily condition and the entrance of medicinal toxins, his viscera and bowel function had lost its regulation and his spleen and stomach had suffered detriment. Dampness had thus accumulated internally and this had led to spleen vacuity and damp obstruction.

The treatment principles in this case were to fortify the spleen, dry dampness, and harmonize the middle for which Huo Xiang Zheng Qi San Jia Jian was chosen. This consisted of: Herba Agastachis Seu Pogostemi (Huo Xiang), 15g, Pericarpium Citri Reticulatae (Chen Pi), processed Rhizoma Pinelliae Ternatae (Ban Xia), Folium Perillae Frutescentis (Su Ye), Caulis Perillae Frutescentis (Su Geng), aged Rhizoma Atractylodis (Cang Zhu), Radix Platycodi Grandiflori (Jie Geng), Radix Angelicae Dahuricae (Bai Zhi), stir-fried Radix Codonopsitis Pilosulae (Dang Shen), and Sclerotium Poriae Cocos (Fu Ling), 10g each, processed Cortex Magnoliae Officinalis (Hou Po) and Radix Auklandiae Lappae (Mu Xiang), 6g each, and Fructus Amomi (Sha Ren) and uncooked Radix Glycyrrhizae (Gan Cao), 3g each. One ji was administered warm per day in two divided doses after having been decocted in water.

After three ji, the patient’s nausea and vomiting were decreased and his tools had form. However, he still had lassitude of the spirit, fatigue, and torpid intake. So 30 grams of Radix Dioscoreae Oppositae (Shan Yao) was added to the above formula. After another five ji, all the man’s symptoms had basically disappeared. Yet he still felt lack of strength and he still did not have any taste when eating or drinking. Therefore, he was administered Xiang Sha Liu Jun Zi Wan (Auklandia & Amomum Six Gentlemen Pills) to continue rectifying and regulating his condition. On follow-up in early 2000, the man’s body had once again become healthy and well.

3. Night sweats

The patient was a 65 year old male who was first examined on May 18, 1997. Three days before, the man had gotten wet and taken a chill. Therefore, he developed headache, head distention, stuffy nose, and aching limbs. He had taken some medicines and his symptoms had decreased. However, after going to sleep, he would sweat to the point he soaked his clothes. When he woke, the sweating stopped. This was accompanied by lassitude of the spirit, torpid intake, and a bitter taste in the mouth. His tongue was fat and pale with slimy, white fur, and his pulse was soggy.

Based on the above signs and symptoms, the man’s Chinese pattern was discriminated as external evils not finished with dampness and heat lodged and stagnating the constructive and defensive, thus resulting in night sweats. The treatment principles were to penetrate, transform, and clear heat and disinhibit dampness. Huo Xiang Zhen Qi San Jia Jian was chosen, which consisted of: Herba Agastachis Seu Pogostemi (Huo Xiang), 15g, Folium Perillae Frutescentis (Su Ye), Rhizoma Atractylodis (Cang Zhu), Sclerotium Poriae Cocos (Fu Ling), processed Rhizoma Pinelliae Ternatae (Ban Xia), Radix Platycodi Grandiflori (Jie Geng), Pericarpium Citri Reticulatae (Chen Pi), Fructus Zizyphi Jujubae (Da Zao), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), and Cortex Phellodendri (Huang Bai), 10g, and uncooked Radix Glycyrrhizae (Gan Cao), 3g. One ji was administered warm each day in two divided doses after being decocted in water. After seven ji, the sweating stopped and the man was cured.    

Conclusion

Do these three cases mean that Huo Xiang Zheng Qi San is a coronary heart disease, chemotherapy syndrome, or night sweat formula? Yes, and no. It means that this formula can be used to treat patients with these three diseases if they have the appropriate pattern. In other words, if the patient’s symptoms are manifestations of wind cold external evils and/or damp turbidity obstructing the center, then this formula may be a good one no matter what their disease diagnosis is. Depending on the complicating patterns and the patient’s exact signs and symptoms, it can then be modified accordingly.

The above article is yet another example of even Chinese practitioners of Chinese medicine trying to clarifying and underscore that, within standard professional Chinese medicine, formulas are prescribed based on patients’ patterns, not on their diseases. While most Western practitioners give lip service to this idea, at the Blue Poppy headquarters, the single most common question we receive from practitioners of Chinese medicine is, "With what formula or how do you treat this or that disease." This is always the wrong first question to ask in professional Chinese medicine. The right question to ask is, "What formula do you suggest for treating these and these patterns and these and these major complaints?"