TCM Prescriptions for Relieving Exterior Syndromes

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Guizhi Tang, Decoction of Cassia Twig
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Ingredients:
No.1  Guizhi(Ramulus Cinnamoni)9 g
No.2  Shaoyao(Radix Paeoniae)9 g
No.3  Zhigancao (Radix Glycyrrhizae Praeparatae) 6 g
No.4  Shengjiang (Rhizoma Zingiberis Recens) 9 g
No.5  Dazao (Fructus Ziziphi Jujubae) 3 pcs

Administration:
Decoct the above drugs in water for oral use.

Actions:
Expelling pathogenic factors from the muscles and skin, and regulating yingqi and weiqi to relieve exterior syndrome.

Clinical Application:
This recipe is indicated for exterior deficiency syndrome due to exogenous wind-cold and syndrome with disharmony between yingqi and weiqi, and yin and yang after illness or delivery, marked by headache, fever, perspiration with aversion to wind, thin whitish fur, superficial and moderate pulse. It is applicable to common cold, flu, urticaria, cutaneous pruritus, and unknown low fever and low fever after delivery or illness and others, which pertain to the disorder between yingqi and weiqi, and yin and yang.

Ingredient No. 2 is now often substituted for Baishaoyao (Radix Paeoniae Alba). If accompanied by stiffness and pain over the neck and back, add Gegen (Radix Puerariae) to dispel pathogenic factors from the body surface and promote the production of body fluid, and relaxation of tendons, forming another recipe entitled Guzhi plus Gegen Tang. If concomitant with cough or asthma, add Houpo (Cortege Magnoliae Officinalis) and Xingren (Semen Armeniacae Arearum) to send down the adversely rising qi for relieving cough and asthma, entitled Guizhi Jia Houpo Xingzi Tang.

Elucidation:
The syndrome is caused by exogenous wind-cold, disharmony between yingqi and weiqi, or debility after illness or delivery and disharmony between yingqi and weiqi, and yin and yang. It should be treated by expelling pathogenic factors from the muscles and skin and regulating yingqi and weiqi. Ingredient No. 1 in the recipe is the monarch drug able to expel pathogenic cold from the muscles and skin and warm the meridians for enhancing yang. No. 2 performs the action of nourishing yin to promote the production of body fluid, and astringing yingqi to suppress sweating, functioning as the minister drug. The combination of the first two ingredients in the same dosage ensures removing wind-cold, consolidating yingqi and yin, harmonizing yingqi and weiqi, and yin and yang.

Ingredient No. 4 performs, in combination with No.1, the double action of dispelling cold and regulating the stomach, and No. 5 with No. 2 the action of replenishing yin and reinforcing the spleen. Therefore these two ingredients serve as adjuvant drugs, enhancing the effect of the monarch and minister drugs in regulating yingqi and weiqi, and yin and yang, as well as reinforcing the spleen and stomach to replenish the source of generation and transformation of yingqi and weiqi. Ingredient No. 3, sweet in flavor, plays the part of adjuvant drug on the one hand, replenishing qi and regulating the stomach. When combined with ingredient No. 1 sweet and pungent in flavor, it expels pathogenic factors from the body surface,and with No. 2 sour and sweet in flavor it transforms yin to regulate yingqi. On the other hand, it plays the role of guiding drug, mediating drug properties.

Both Mahuang Tang and Guizhi Tang are used to treat exterior syndrome due to exogenous wind-cold. Mahuang (Herba Ephedrae) and Guizhi (Ramulus Cinnamomi) plus Xingren ( Semen Armeniaccae Amarum ) in Mahuang Tang are to enhance the effect of inducing sweating and dispelling cold, capable of dispersing the lung and relieving asthma. It is a drastic prescription of inducing sweating with pungent and warm drugs. And it is applicable to the exterior excess syndrome due to exogenous wind-cold, marked by aversion to cold, fever without perspiration, cough and asthma.
While, Guizhi (Ramulus Cinnamoni ) and Baishaoyao ( Radix Paeoniae Alba ) plus Shengjiang (Rhizome Zingiberis Recens) and Dazao (Fructus Ziziphi Jujubae) are used in Guizhi Tang, its action of relieving the exterior syndrome by means of inducing sweating is not so strong as that of Mahuang Tang, but stronger in regulating yingqi and weiqi. It is applicable to exterior deficiency syndrome due to exogenous wind-cold, marked by fever with perspiration, and aversion to wind.

Cautions:
This recipe is mild in its action of inducing sweat, so is called "dispelling pathogenic factors from muscles and skin" and not applicable to patients of exterior syndrome due to exogenous wind-cold but without perspiration. The patient has to take one bowl of hot gruel after administration of the decoction and put on more clothes or quilts to help induce sweat.



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