A Time of Untimely Seasonal Qì

On Huò Xiāng Zhèng Qì Sǎn

Winter in the tropics of South Florida has this year included a stiff and prolonged dose of windy, cold weather, with the temperatures warming up enough to make occasional rain and then dropping again. Many of the clientele here at Mulch HQ have succumbed to the seasonal pathogens, and in most of these cases the manifestations are remarkably similar to those of the Malign Guest Qì of 2020 that swept across the globe – and yet, none of them have tested positive for the MGQ20 despite numerous tries. Additionally, the pathogen is quite sticky, tends to linger, and frequently recurs.

In 2020, I published my thoughts on social media regarding what I understood about the nature of the majority of cases of the MGQ, based on what I was reading and hearing – the clinic was temporarily shut down at the time. I referenced a podcast that I had listened to that featured an interview with a doctor in China:

“The TL;DR is that what he (and others) were seeing was an epidemic of cold damp toxin. Their primary treatment strategy involved herbs from the drain damp category, but of primary importance was the category of aromatic herbs that transform dampness. In other words, herbs like huo xiang, hou po, ban xia, fu ling, and so forth. To these they added small amounts of anti-viral herbs like ban lan gen or jin yin hua, as well as cough-stopping herbs like xing ren. But Jin Zhao [the doctor] was adamant, the main strategy was treating the dampness.”

This was completely borne out in my practice later that year and now again, despite all the negative tests. At the time, the major exterior damp formulas as well as all the toxin-resolving herbs were completely sold out, so I advocated using Kang Ning Wan, or Curing pills, which were basically the same category of formulas as the aromatic dry damp prescriptions.

Now, of course, our backs are nowhere near as up against the wall as they had been four years ago, and so I have been using a lot of Huò Xiāng Zhèng Qì Sǎn (Pogostemon Correct Qì Powder) [HXZQS] as well as stocking folks up for acute as-needed administration in cases of relapse. It is a formula well-suited to the current weather here; it helps to relieve the headache, open the chest, and address the heaviness and oppression of the head, body and limbs that comes with this kind of damp-cold attack. It suffices for the wèi into the qì aspects, unless there is a pivot into the shàoyáng channels in the qì aspect which would call for Wēn Dǎn Tāng or the like.

With this in mind, I figured I would put up a post on the formula.

Origin of the Prescription

HXZQS first appeared in the Tài Píng Huì Mín Hé Jì Jú Fāng《太平惠民和劑局方》 (Imperial Grace Formulary of the Tài Píng Era), in 1078. My working version of the entry I found there is as follows:

藿香正氣散

治傷寒頭疼，憎寒壯熱，上喘咳嗽，五勞七傷，八般風痰，五般膈氣，心腹冷痛， 反胃嘔惡，氣瀉霍亂，臟腑虛鳴，山嵐瘴瘧，遍身虛腫；婦人產前、產後， 血氣刺痛；小兒疳傷，並宜治之。

大腹皮　白芷　紫蘇　茯苓（去皮）各一兩、 半夏曲　白朮　陳皮（去白）厚朴（去粗皮，薑汁炙）苦梗各二兩　藿香（去土）、 三兩　甘草（炙）二兩半上為細末。每服二錢，水一盞，薑錢三片，棗一枚， 同煎至七分，熱服。如欲出汗，衣被蓋，再煎並服。

Huò Xiāng Zhèng Qì Sǎn

Treats cold damage headache, abhorrence of cold with vigorous heat [effusion], ascendant panting and cough, five taxations and seven damages, eight kinds of wind phlegm, five kinds of diaphragm qì, heart and abdomen cold pain, stomach reflux, nausea and retching, qì diarrhea and heat cholera, viscera and bowel vacuity rumbling, mountain forest miasmic malaria, vacuity swelling of the whole body; in females, antepartum, postpartum, blood and qì stabbing pains; it is appropriate to treat pediatric gān damage, as well.

Dà Fù Pí [Pc Arecae], Bái Zhǐ [Rx Angelicae Dahuricae], Zǐ Sū [Fm Perillae], Fú Líng [Poria] (remove peel), each 1 liǎng; Bàn Xià Qū [Massa Pinelliae Fermentata], Bái Zhú [Rz Atractylodis Macrocephalae], Chén Pí [Pc Citri Reticulatae ] (remove white part) Hòu Pò [Cx Magnoliae Officinalis] (remove the thick peel, fry in jiāng zhī/ ginger juice), Kǔ Gěng [Rx Platycodi] each 2 liǎng; Huò Xiāng [Hb Pogostemonis] (remove dirt), 3 liǎng; Gān Cǎo (Zhì)  [Rx Glycyrrhizae preparata] 2.5 liǎng; grind into a fine powder. Each dose is 2 qián, in a small cup of water, with 1 qián of Jiāng [Rz Zingiberis Recens] cut into 3 slices, Zǎo [Fr Jujubae] 1 piece, decoct together until 7/10 [of the liquid remains], take hot. When it appears that the patient will start sweating, cover them with clothing or a blanket, decoct again and take.

A View from the Míng

Another view of the formula can be found in the Yī Fāng Kǎo [Investigation of Medical Formulas, 醫方考] written by Wú Kūn during the Míng period, in 1584.

凡受四時不正之氣，憎寒壯熱者，此方主之。

風寒客於皮毛，理宜解表，四時不正之氣由鼻而入，不在表而在裡，故不用大汗以解表，但用芬香利氣之品以主之；白芷、紫蘇、藿香、陳皮、腹皮、厚朴、桔梗，皆氣勝者也，故足以正不正之氣；白朮、茯苓、半夏、甘草，則甘平之品耳，所以培養中氣，而樹中營之幟者也。

All cases in which one receives untimely seasonal qì, with abhorrence of cold and vigorous heat effusion, this formula masters it.

[If] wind cold lodges at the skin and hair, the appropriate principle is to resolve the exterior, but untimely seasonal qì enters through the nose, it is not at the exterior nor at the interior, therefore one need not use strong sweating to resolve the exterior, but use fragrant qì-disinhibiting substances to master it; Bái Zhǐ, Zǐ Sū, Huò Xiāng, Chén Pí, Fù Pí, Hòu Pò, Jié Gěng, in each of them their qì is dominant, so much so as to correct the malign qì. Bái Zhú, Fú Líng, Bàn Xià, Gān Cǎo, are just sweet and balanced substances, and so bank up and nourish the central qì, and plant the banner of the central camp [yíng].

In another section of the text, Wú writes:

內傷、外感而成霍亂者，此方主之。

內傷者調其中，藿香、白朮、茯苓、陳皮、甘草、半夏、厚朴、桔梗、大腹皮，皆調中藥也，調中則能正氣於內矣；外感者疏其表，紫蘇、白芷，疏表藥也，疏表則能正氣於外矣。若使表無風寒，二物亦能發越脾氣，故曰正氣。

In cases of interior damage, or exterior contraction that develops into sudden turmoil, this formula is its master.

In cases of interior damage, [one should] regulate the center, Huò Xiāng, Bái Zhú, Fú Líng, Chén Pí, Gān Cǎo, Bàn Xià, Hòu Pò, Jié Gěng, Dà Fù Pí, each is a medicinal that regulates the center, and regulating the center can therefore correct the qì on the inside; in cases of external contraction, [one should] course the exterior, Zǐ Sū and Bái Zhǐ are exterior-coursing medicinals, and coursing the exterior can therefore correct the qì on the outside. If the exterior envoys are not wind and cold, these two ingredients can also effuse and spread the spleen qì, which can still be called correcting the qì [正氣, zhèng qì, in reference to the formula name].

Formula Actions and Composition

At its heart, HXZQS is a formula to rectify the qì dynamic, dry dampness and support the spleen. The composition can be seen as three main clusters of medicinals: the first, from the aromatic dry dampness category, which parch damp in the center and provide not only dispersive but downbearing action; the second, warm acrid exterior-resolving herbs which open the chest and relieve headache, and provide an upbearing impetus; and the third, taken from Liù Jūn Zǐ Tāng (Six Gentlemen Decoction) with Rén Shēn [Rx Ginseng] removed.

There are cross-relationships between the groups, of course. Bàn Xià and Hòu Pò, both downbearing, eliminate phlegm; Dà Fù Pí and Chén Pí both regulate qì in the abdomen and resolve puffy edema in the skin layer. Jié Gěng and Zǐ Sū Yè both open the chest. There are formula elements other than Liù Jūn Zǐ Tāng here as well: Bàn Xià Hòu Pò Tāng, Er Chen Tāng, Wu Pí Wán.

Above it all is the chief herb, Huò Xiāng, which ascends and scatters with its intense fragrance. I tried to capture some of the herb relationships and movement dynamics in the graphic, but it is difficult to convey every feature of a formula without cluttering the diagram.

 Acupuncture Treatment

The types of point combinations I have been using for these recent cases fall in line with some that I recently posted on. The principles are to resolve the exterior, dry dampness, rectify the qì dynamic especially of the upper and central burners; and to address branch manifestations like opening the nasal orifice.

I usually choose from the following points:

• Resolve the exterior: LU7, TB5; UB12, GB20 (if possible)

• Dry dampness in the upper and central burner, as well as the muscle layer: SP5, SP9

• Rectify qì dynamic in upper and central burner: LU5, LU6, SP4, SP8; Ren12, Ren17 (if possible)

• Open the nasal orifices: Yìn Táng, Bí Tōng, Du23

This is essentially a wèi / qì aspect lung deficiency/spleen dampness pattern. Recurrent relapses may call for a shift to treating the wèi aspect kidney pattern.

Conclusion

This has been an active winter season here with the surge in cases of who-knows-what-it-could-be. In terms of treating with Chinese medicine, of course, we rely on our predecessors and take what they left for us into the present day, adjusting as needed. Once the winter is behind us, we have the springtime and its particular qì ahead of us. And so it goes.

As always, thanks for reading.

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Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

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References

Tài píng huì mín hé jì jú fāng. (1078). Retrieved February 7, 2024, from https://jicheng.tw/tcm/book/%E5%A4%AA%E5%B9%B3%E6%83%A0%E6%B0%91%E5%92%8C%E5%8A%91%E5%B1%80%E6%96%B9/index.html

Wú, K. (1584). Yī fāng kǎo. Retrieved February 7, 2024, from https://jicheng.tw/tcm/book/%E9%86%AB%E6%96%B9%E8%80%83/index.html