Herbal Monograph for Xiao Chai Hu Tang

By John Chen, PhD, PharmD, OMD, LAc

Xiao chai hu tang (Minor Bupleurum Decoction) is one of the most commonly used herbal formulas
today. Historically, it was used to treat shaoyang syndrome. Today, it is used to successfully treat
many disorders including hepatitis, liver fibrosis, liver cancer, jaundice, cholecystitis, cholelithiasis,
pancreatitis, nephritis, acute tonsillitis, parotitis, stomatitis and many more. To achieve optimal
therapeutic outcome, it is of critical importance to learn beyond the traditional aspect of this
formula. Understanding of topics such as pharmacological effect, clinical studies and research,
toxicology and herb-drug interactions will greatly empower the practitioners to properly select the
best herbal formula for treatment. Listed below is the herbal monograph on Xiao chai hu
tang (Minor Bupleurum Decoction), an excerpt from Chinese Herbal Formulas and Applications by
John and Tina Chen, to be published by Art of Medicine Press in fall, 2007.

Xiao Chai Hu Tang (Minor Bupleurum Decoction)

Pinyin Name: Xiao Chai Hu Tang
Literal Name: Minor Bupleurum Decoction
Alternate Names: Hsiao Tsai Hu Tang, Minor Bupleurum Combination
Original Source: Shang Han Lun (Discussion of Cold-Induced Disorders) by Zhang Zhong-Jing in
the Eastern Han Dynasty

Composition

Chai Hu (Radix bupleuri) 24g [12g]

Huang Qin (Radix scutellariae) 9g [9g]

Ban Xia (Rhizoma pinelliae), xi (washed) 0.5 cup [9g]

Sheng Jiang (Rhizoma zingiberis recens), qie (sliced "Slicing") 9g [9g]

Ren Shen (Radix et rhizoma ginseng) 9g [6g]

Zhi Gan Cao (Radix et rhizoma glycyrrhizae praeparata cum melle) 9g [5g]

Da Zao (Fructus jujubae), bo (opened) 12 pieces [4 pieces]

Dosage/Preparation/Administration

The source text specifies to cook the ingredients in 12 cups [2400 mL] of water until 6 cups [1200
mL] of the liquid remain. Discard the residue and cook the strained decoction again until it is
reduced to 3 cups [600 mL]. Take 1 cup [200 mL] of warm decoction per dose, three times daily.
Today, the decoction may be prepared using the dosages suggested in brackets.

Chinese Therapeutic Actions

Harmonizes shaoyang

Clinical Manifestations

1. Shaoyang syndrome: alternating spells of fever and chills, chest and hypochondriac fullness and
discomfort, irritability, a bitter taste in the mouth, lack of appetite, nausea, vomiting, vertigo, a
dry throat, a thin, white tongue coating and a wiry pulse.
2. Any of the following disorders with shaoyang characteristics: gynecological disorders with heat
in the uterus, liver or chong (thoroughfare) channel; malaria; jaundice; or any internal injury
characterized by shaoyang syndrome.
Clinical Applications

Hepatitis, viral hepatitis, chronic hepatitis, hepatic fibrosis and carcinoma, hepatocellular
carcinomas, jaundice, cholecystitis, cholelithiasis, pancreatitis, fever, fever in cancer, nephritis,
chronic renal insufficiency, acute tonsillitis, infectious parotitis, stomatitis, common cold, influenza,
measles, bronchitis, pneumonia, pulmonary tuberculosis, cough, allergic rhinitis, bronchial
asthma, reflux esophagitis, antral gastritis, gastritis, gastric pain, gastric prolapse, constipation,
Meniere's syndrome, dizziness, seizures, migraine, angina, depression, chronic fatigue syndrome,
morning sickness, postpartum infection, postpartum fever, dysmenorrhea, premenstrual syndrome
and malaria.

Explanation

Xiao chai hu tang (Minor Bupleurum Decoction) is the main formula for

harmonizing shaoyang syndrome, one of the six stages of disease progression described in Shang
Han Lun (discussion of cold-induced disorders). The shaoyang is situated between yang and yin,
or between the exterior and interior; therefore, alternating spells of fever and chills may occur
in shaoyang syndrome if the body is fighting both the pathogens outside and the disharmony
inside.

Disorders in the shaoyang might cause qi stagnation and eventual heat formation in the

gallbladder channel (a shaoyang channel), giving rise to chest and hypochondriac fullness and
discomfort, a bitter taste in the mouth, vertigo, a dry throat and irritability. Lack of appetite,
nausea and vomiting are the results of gallbladder heat invading the stomach. The tongue coating
is thin and white because the pathogenic factors have not yet transformed into internal heat. The
wiry pulse is the result of qi stagnation in the shaoyang channel.

Because the disease resides between the exterior and the interior, it is not suitable to use only
exterior-releasing herbs or only purgative herbs. Use of only exterior-releasing herbs will not treat
the interior condition, and use of only heat-clearing or downward-draining herbs will bring the
pathogens from the exterior into the interior. Therefore, the harmonizing method is the most
appropriate treatment approach in this condition.

Chai hu (Radix bupleuri) is the main herb for treating shaoyang disorders. The light quality of chai
hu (Radix bupleuri) lifts and disperses stagnation, as well as releases to the exterior. Huang
qin (Radix scutellariae), a bitter and cold herb that enters the gallbladder channel, is ideal for
clearing shaoyang heat. Together, chai hu (Radix bupleuri) disperses the exterior while huang
qin (Radix scutellariae) clears the interior to achieve the harmonizing effect. Ban xia (Rhizoma
pinelliae), besides harmonizing the stomach to relieve nausea and vomiting, disperses stagnation
in the body. Sheng jiang (Rhizoma zingiberis recens) helps ban xia (Rhizoma pinelliae) harmonize
the middle jiao. It also reduces the toxicity of ban xia (Rhizoma pinelliae). Ren shen (Radix et
rhizoma ginseng), zhi gan cao (Radix et rhizoma glycyrrhizae praeparata cum melle), and da
zao (Fructus jujubae) tonify stomach qi, nourish body fluids and harmonize the ying (nutritive)
and wei (defensive) levels. The combination of chai hu (Radix bupleuri) and ren shen (Radix et
rhizoma ginseng) also provides a mutual check and balance for each other: chai hu (Radix
bupleuri) prevents the tonic effect of ren shen (Radix et rhizoma ginseng) from retaining the
pathogens in the body, while ren shen (Radix et rhizoma ginseng) prevents the dispersing effect
of chai hu (Radix bupleuri) from damaging qi. Combined, these herbs expel the pathogens and
strengthen bodily constitution.

Because the shaoyang stage is unstable and often short and transient, the symptoms listed above
may not be clinically present all at the same time. Therefore, as suggested in shang han
lun (discussion of cold-induced disorders), this formula can be applied even if there is only
one shaoyang symptom clinically present.

Xiao Chai Hu Tang (Minor Bupleurum Decoction)

 Diagnosis Signs and Symptoms Treatment Herbs

Shaoyangsyndrome  Alternating spells of Harmonizes shaoyang  Chai hu (Radix

fever and chills: the bupleuri) releases
location of the illness the exterior,
between exterior and and huang
interior. qin (Radix
 Chest and scutellariae) clears
hypochondriac fullness the interior.
and Together, they
discomfort: qi stagnation. harmonize shaoyang
 A bitter taste in the disorders.
mouth, a dry throat, and  Ban xia (Rhizoma
irritability: heat in pinelliae)
the shaoyang gallbladder harmonizes the
channel. stomach to relieve
 Lack of appetite, nausea and
nausea, and vomiting: vomiting, and
gallbladder heat invading disperses
the stomach. stagnation.
 Thin, white tongue  Sheng
coating: exterior jiang (Rhizoma
condition. zingiberis Recens)
 Wiry harmonizes the
pulse: qi stagnation. middle jiao.
 Ren shen (Radix
et rhizoma
ginseng), zhi gan
cao (Radix et
rhizoma glycyrrhizae
praeparata cum
melle), and da
zao (Fructus
jujubae) tonify
Stomach qi, nourish
body fluids, and
harmonize
the ying (nutritive)
and wei (defensive)
levels.

Modifications

General Signs and Symptoms:

 If accompanied by headache, add chuan xiong (Rhizoma chuanxiong).

 If there is thirst, remove ban xia (Rhizoma pinelliae) and add tian hua fen (Radix trichosanthis).
 With thirst and irritability from deficiency in heat, add mai dong (Radix ophiopogonis) and wu
wei zi (Fructus schisandrae chinensis).
 If there is no thirst but a slight fever and exterior symptoms are present, remove ren
shen (Radix et rhizoma ginseng) and add gui zhi  (Ramulus cinnamomi).
 With irritability, add dan zhu ye (Herba lophatheri) and geng mi (Semen oryzae).
 With more irritability but absence of nausea or vomiting, remove ban xia (Rhizoma pinelliae)
and ren shen (Radix et rhizoma ginseng) and add gua lou (Fructus trichosanthis).
 With abdominal pain, remove huang qin (Radix cutellariae) and add bai shao (Radix paeoniae
alba).
 With more vomiting or nausea, add sheng jiang (Rhizoma zingiberis recens) and chen
pi (Pericarpium citri reticulatae).
 When there is indigestion in children, add bai zhu (Rhizoma atractylodis macrocephalae), chen
pi (Pericarpium citri reticulatae), fu ling (Poria) and shan zha (Fructus crataegi).
 If there is gum pain caused by yin deficiency, add shi gao (Gypsum fibrosum).
  With palpitations and dysuria, remove huang qin (Radix scutellariae) and add fu ling (Poria).
 With distention and hardness of the hypochondriac area caused by phlegm accumulation,
remove da zao (Fructus jujubae) and add mu li (Concha ostreae).
 If the hypochondriac pain is severe, add qing pi (Pericarpium citri reticulatae viride), bai
shao (Radix paeoniae alba) and xiang fu (Rhizoma cyperi).
 With a stifling sensation in the chest, add zhi shi (Fructus aurantii immaturus) and qing
pi (Pericarpium citri reticulatae viride).

Infectious Disorders:

 For common colds, add jing jie (Herba schizonepetae), fang feng (Radix saposhnikoviae)

and ge gen (Radix puerariae lobatae).
 For influenza, add jin yin hua (Flos lonicerae japonicae), lian qiao (Fructus forsythiae) and ban
lan gen (Radix isatidis).
 For acute bronchitis, add jie geng (Radix platycodonis), zhi qiao (Fructus aurantii), ku xing
ren (Semen armeniacae amarum) and bai bu (Radix stemonae).
 For chronic bronchitis, add fu ling (Poria), chen pi (Pericarpium citri reticulatae), zi wan (Radix
et rhizoma asteris) and kuan dong hua (Flos farfarae).
 For acute otitis media, add long dan (Radix et rhizoma gentianae) and zhi zi (Fructus
gardeniae).
 For urinary tract infection, add bian xu (Herba polygoni avicularis), che qian cao (Herba
plantaginis) and hai jin sha (Spora lygodii).
 For malaria, add chang shan (Radix dichroae), bing lang (Semen arecae) and wu mei (Fructus
mume).

Liver and Gallbladder Disorders:

 For icteric jaundice and hepatitis, add zhi shi (Fructus aurantii immaturus), yin chen (Herba
artemisiae scopariae), bai shao (Radix paeoniae alba) and jin qian cao (Herba lysimachiae).
 For damp-heat jaundice, add yin chen (Herba artemisiae scopariae), zhi zi (Fructus gardeniae)
and ban lan gen (Radix isatidis).
 For jaundice with more heat, add zhi zi (Fructus gardeniae) and huang bo (Cortex phellodendri
chinensis).
 For jaundice resulting from hepatitis or cholecystitis, add zhi shi (Fructus aurantii
immaturus), yin chen (Herba artemisiae scopariae), bai shao (Radix paeoniae alba) and jin qian
cao (Herba lysimachiae).

Gynecological Disorders:

 For postpartum wind invasion with perspiration, remove chai hu (Radix bupleuri).

 For postpartum wind invasion without fever, remove huang qin (Radix scutellariae).
 For postpartum wind invasion with increased vomiting or nausea, increase the dosage of sheng
jiang (Rhizoma zingiberis recens).
 For postpartum wind invasion with marked deficiency, increase the dosage of ren shen (Radix et
rhizoma ginseng).
 When there is wind invasion during the menstrual period, add niu xi (Radix achyranthis
bidentatae), tao ren (Semen persicae) and mu dan pi (Cortex moutan).

Cautions/Contraindications

 Xiao chai hu tang should be used with caution in patients of yin and/or blood deficiencies, in
patients of upper excess and lower deficiency, or in patients of liver fire. Inappropriate use of this
formula may result in headache, dizziness or bleeding gums.
 In general, there is no sweating associated with relief of symptoms following the administration
of Xiao chai hu tang, since it harmonizes, rather than releases the exterior. However, some
patients do show sweating prior to recovery. They should be monitored closely to prevent
excessive sweating from injuring yin.
 Avoid cold, raw, pungent and spicy foods while taking this formula.1
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Editor's Note: Part 2 of this article will appear in the August 2007 issue of Acupuncture Today.

Click here for previous articles by John Chen, PhD, PharmD, OMD, LAc.

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