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Bupleurum & Angelica
(now Liquid formula)

This formula is a modification of Zhang Zhong-jing's Xiao Chai Hu Tang (Minor Bupleurum Decoction) with additional ingredients based on Bob Flaws's research and clinical experience. Our version is a 12:1 extract.

Rx:

Radix Angelicae Dahuricae (Bai Zhi)
Radix Ligustici Wallichii (Chuan Xiong)
Radix Scutellariae Baicalensis (Huang Qin)
Fructus Forsythiae Suspensae (Lian Qiao)
Flos Lonicerae Japonicae (Jin Yin Hua)
Radix Bupleuri (Chai Hu)
Rhizoma Pinelliae Ternatae (Chen Pi)
Radix Codonopsitis Pilosulae (Dang Shen)
Fructus Crataegi (Shan Zha)
Endothelium Corneum Gigeriae Galli (Ji Nei Jin)
Rhizoma Acori Graminei (Shi Chang Pu)
Pericarpium Citri Reticulatae (Chen Pi)
Fructus Zizyphi Jujubae (Da Zao)
Radix Glycyrrhizae (Gan Cao)

Indications: This formula is meant for the treatment of pediatric food stagnation transforming into heat and ascending through internal branches of the large intestine channel to steam and fume in the region of the ear. This pattern is commonly seen in pediatric otitis media characterized by pain, fever, restlessness, ear-tugging, but no purulent discharge. Commonly, children with this pattern exhibit the complication of spleen vacuity.

SIGNS AND SYMPTOMS OF FOOD STAGNATION BREWING HEAT INCLUDE:
Fever
Restlessness and agitation which are commonly worse in the evening
Bad breath
Red face
Red fingernails, warm fingers and toes
Torpid intake
An engorged, purple red vein at the wind bar (Feng Guan)
Regurgitation of undigested food or curdled milk
Possible constipation or diarrhea with putrid smell
Red, possibly dry lips

SIGNS AND SYMPTOMS OF SPLEEN VACUITY INCLUDE:
A blue vein at the root of the nose (Shan Gen)
A tendency to loose stools
Fatigue, listlessness
Inherent immaturity
Possible cold hands and feet
A history of antibiotic use

FORMULA EXPLANATION:
This formula is based on Zhang Zhong-jing's Xiao Chai Hu Tang. However, it is not being used as a harmonizing formula, or at least not to harmonize the constructive and defensive. It is also difficult to definitively diagnose an exterior pattern in infants due to inability to question and to reliably feel the pulse, remembering that the defining characteristics of a wind heat exterior pattern are emission of heat (i.e., fever), chills, sore throat, and a floating, rapid pulse. Chills and sore throat require the ability to verbally question to obtain, and it is often difficult to reliably detect a floating pulse in the inch position in extremely small, typically squirming patients. Therefore, in designing this primarily pediatric formula, it is the functions of the ingredients of Xiao Chai Hu Tang which are most important rather than classical descriptions of this formula. According to Chinese medical theory, infants' spleens and stomachs are inherently immature. This means that they do not do their functions in an efficient and mature way. The functions of the stomach are to rotten and ripen and, after that, downbear the turbid. The functions of the spleen are to move and transform by upbearing the clear. Therefore, if the spleen and stomach do not do these functions, food may accumulate and stagnate in the stomach and intestines. Because stagnant food impedes the free flow of yang qi, yang qi may become depressed and transform into heat. Because heat is yang, it tends to travel upward along the yang channels of the large intestine, stomach, and gallbladder. Because the cranium is a bony box, heat counterflowing upwards may become trapped and then linger and brew in the cavities of this box, such as the ears, nose (including the sinuses), and throat, thus giving rise to otitis media, rhinitis/sinusitis, and laryngitis.

Crataegus and Chicken Gizzard both transform food and disperse stagnation, especially when that stagnation is due to "meaty" foods. Meaty foods in Chinese medicine include milk products. Scutellaria clears heat from the lungs, stomach, and intestines. Forsythia and Lonicera clear heat toxins as well as abate fever. These are the three heat-clearing medicinals in this formula. Codonopsis and Red Dates fortify the spleen and supplement the qi. Pinellia, Orange Peel, and uncooked Ginger harmonize the stomach and transform phlegm and dampness. Ligusticum Wallichium and Bupleurum both upbear the qi and, hence, lead the other medicinals upward. They also both enter the shao yang. The shao yang channels encircle the ears and, even though the heat of pediatric earaches may not always come primarily from the liver, moving and out-thrusting the yang qi from these channels can disperse heat evils accumulated in the region of the ear which may have originated in the stomach and intestines. Further, because infants' livers inherently " have a surplus," any evil heat in a baby's body can mutually engender heat in the liver. Ligusticum also moves the blood. Thus, in short, these two medicinals in this formula are meant to stop ear pain. Acorus transforms phlegm and opens the orifices, including the orifices of the ear. Angelica Dahurica also opens the orifices of the ears and nose and strongly stops pain. Although it is an acrid, warm exterior-resolving medicinal, it also reduces swelling and expels pus, typically a damp heat/heat toxin phenomenon. And finally, uncooked Licorice is meant to A) harmonize the other ingredients in the formula, thus protecting the spleen and stomach from damage by bitter, cold medicinals, and B) aid in clearing heat and resolving toxins.

DOSAGE:
Two capsules two times per day equal not less than 24g of raw medicinals. Since infants cannot swallow capsules, one or more capsules should be opened and their contents mixed with warm water. Stir the extract until dissolved. Then administer two eye-droppers of this liquid 4-6 times per day or even more as needed. Typically, babies do not require large doses and commonly respond better to repeated small doses.

NOTE:
Over-feeding, as in feeding on demand, may cause food stagnation as may feeding hard-to-digest substances and substances which damage the spleen. This includes sugars and sweets, chilled, frozen foods and drinks, and raw, uncooked foods. Therefore, proper diet is crucially important in the overall treatment of children with either acute or chronic otitis media. In general, Chinese medicine recommends a clear, bland, hypoallergenic, yeast-free anti-candidal diet. Chinese doctors in China and the West have confirmed that antibiotics may also damage the spleen. Post-antibiotic spleen vacuity syndrome has now become a recognized syndrome in the Chinese medical literature.