Use Sweet and Cold to Rescue the Fluids
On Shā Shēn Mài Mén Dōng Tāng
Autumn is passing quickly in the Northern Hemisphere. For us here in the tropics, the dry season is just beginning. Either way, the air generally becomes more arid, and symptoms of dryness start to show up in the clinic. Today we’ll look at a formula we have found useful in many such situations, and a few more besides.
Shā Shēn Mài Mén Dōng Tāng
Shā Shēn Mài Mén Dōng Tāng (Glehnia and Ophiopogon Decoction, abbreviated SSMMDT) was composed by Wú Jūtōng and cited in a brief entry in his Wēn Bìng Tiáo Biàn (Differentiation of Warm Disease, published 1813). It is found in clause 56 of the Upper Burner section, discussing the pathogenic factor of Autumn Dryness (Qiū Zào):
５６燥傷肺胃陰分，或熱或咳者，沙參麥冬湯主之。
此條較上二條，則病深一層矣，故以甘寒救其津液。
〔沙參麥冬湯方〕甘寒法。
沙參三錢，玉竹二錢，生甘草一錢，冬桑葉一錢五分，麥冬三錢，生扁豆一錢五分，花粉一錢五分。
水五杯，煮取二杯，日再服，久熱久咳者，加地骨皮三錢。
56 Dryness damaging the Lung and Stomach Yīn aspect, possibly with fever or cough, Shā Shēn Mài Dōng Tāng (Glehnia and Ophiopogon Decoction) governs. Compared with the 2 articles above [54 - 55, on Sāng Xìng Tāng (Mulberry Leaf and Apricot Kernel Decoction) and Sāng Jú Yǐn (Mulberry Leaf and Chrysanthemum Decoction) - ed.], this disease is one layer deeper, so use sweet and cold to rescue the fluids (jīn yè).
Shā Shēn Mài Dōng Tāng (Glehnia and Ophiopogon Decoction) prescription, sweet and cold method.
Shā Shēn (Glehniae Radix) 3 qián, Yù Zhú (Polygonati odorati Rhizoma) 2 qián, fresh Gān Cǎo (Glycyrrhizae Radix) 1 qián, winter Sāng Yè (Mori Folium) 1 qián 5 fēn, Mài Dōng (Ophiopogonis Radix) 3 qián, fresh Biǎn Dòu (Lablab Semen album) 1 qián 5 fēn, Huā Fěn (Trichosanthis Radix) 1 qián 5 fēn.
Five cups of water, boil and take two cups, take daily. For persistent heat and cough, add 3 qián of Dì Gǔ Pí (Lycii Cortex).
Formula analysis
The primary sweet cold herbs are Shā Shēn and Mài Mén Dōng, a synergistic pair to moisten the Lungs and Stomach. (Tiān) Huā Fěn is slightly sweet yet bitter and cold; it clears Lung heat and can help dislodge any stuck phlegm left over in the Lung. Yù Zhú is the ingredient of choice to supplement Yīn in the presence of an exterior pathogen; it is important to remember the context of the formula, which is invasion by warm dryness. Though Wú states that the disease is at a deeper level than the more superficial dryness formulas, SSMMDT still contains Wèi-level surface-freeing Sāng Yè, which, when picked in the winter, has a stronger ability to vent pathogenic factors from the exterior. Ensuring the tonification of the Spleen, mother of the Lung and partner of the Stomach, is Biǎn Dòu and Gān Cǎo, here both fresh to better help clear heat, but both may be prepared if necessary.
Applications of SSMMDT
Maclean et al. (2018) lists SSMMDT in the entries for abdominal masses, anorexia/low appetite, cough, dysphagia (difficulty swallowing), regurgitation, and tiredness. Maciocia (2022) includes the formula in chapters for reflux, asthma, chronic fatigue, constipation, cough, epigastric pain, thyroid dysfunction, nausea/vomiting, and tiredness.
In our clinic, we often dispense the formula in pills or capsules, but also use it as a basis for granule prescriptions. Some of the applications we have employed include:
· Dry type allergic asthma, smoke or chemical exposure causing symptoms of Lung dryness. This may or may not take on the typical tongue picture (peeled or geographic) of Lung-Stomach Yīn deficiency; it depends on the chronicity of the problem. But the etiology is generally dry pathogenic factors as opposed to a constitutional Yīn deficiency.
· Useful in later stages of, or convalescence from, COVID-19 (Huang et al., 2020). We saw a case in which the infection was past the acute phase but the symptoms of dry cough, fatigue and low fever persisted, accompanied by an outbreak of hives over the whole body. The prescription was SSMMDT plus Dì Gǔ Pí for the cough (Wú’s modification); also Tài Zǐ Shēn (Pseudostellariae Radix) to supplement qi and fluids; with Chán Tuì (Cicadae Periostracum), Jīng Jiè (Schizonepetae Herba) and Fáng Fēng (Ledebouriellae Herba) added to vent the surface. The hives abated quickly and the other symptoms followed shortly.
· Sjögren's syndrome. A vexing clinical problem we’ve treated over the years, SSMMDT can prove very useful for people with Sjögren's (Jiang et al., 2021). There is usually some underlying Spleen deficiency which differentiates the use of this formula from the heavier Yīn tonic prescriptions. The syndrome is multifaceted enough to dedicate a separate article, which we are planning for the future.
· We have found this formula useful for persons fasting Ramaḍān. Fasting the month requires long periods without hydration, often in warm temperatures. A fluid deficit may develop quickly and lead to hardship and possible inability to bear the fast. Though this is not a case involving dry pathogens, nevertheless injury to jīn yè can occur and SSMMDT is a cold, sweet, lightly nourishing formula that is well tolerated by most people.
Conclusion
SSMMDT has become an indispensable formula here at Clinical mulch HQ. It’s a Wen Bing prescription with a very clear Five-Phase strategy, which of course endears it that much more to us. But mostly it is a nice, light, effective remedy for which we continue to discover new clinical applications.
Note: this newsletter 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.
References
Huang, S. T., Lai, H. C., Lin, Y. C., Huang, W. T., Hung, H. H., Ou, S. C., Lin, H. J., & Hung, M. C. (2020). Principles and treatment strategies for the use of Chinese herbal medicine in patients at different stages of coronavirus infection. American journal of cancer research, 10(7), 2010–2031.
Jiang, Y., Zhao, X., Yu, J., Wang, Q., Wen, C., & Huang, L. (2021). Deciphering potential pharmacological mechanism of Sha-Shen-Mai-Dong decoction on primary Sjogren's syndrome. BMC complementary medicine and therapies, 21(1), 79. https://doi.org/10.1186/s12906-021-03257-7
Maciocia, G. (2022). The practice of Chinese medicine: The treatment of diseases with acupuncture and Chinese herbs. (3rd Edition). Elsevier Health Sciences (US).
Maclean, W., Lyttleton, J., Bayley, M., & Taylor, K. (2018). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese medicine. Eastland Press.
Wu, J.T. (1813). Wēn bìng tiáo biàn. Retrieved October 30, 2022 from https://jicheng.tw/tcm/book/%E6%BA%AB%E7%97%85%E6%A2%9D%E8%BE%A8_1/index.html