Transform Phlegm and Dispel Wind
On Bàn Xià Bái Zhú Tiān Má Tāng
First, I want to extend a welcome to everyone who has subscribed recently. Thanks for your interest in our publication.
What’s new at CM HQ
It’s been busy here at Clinical mulch HQ. A collaboration with TCM Academy is in the works and we’ve been getting everything in place to hopefully launch in mid-December. The topic of the course I’m preparing is treatment of headaches, and I have been putting the course content together over the last couple of weeks, which includes researching texts. Not all of the research will make it into the presentation, so I will be mulching some of it here and giving a peek into some of the materials I am working on.
Hence the infographic above; included in the course discussion are headaches due to turbid phlegm, the standard remedy for which is Bàn Xià Bái Zhú Tiān Má Tāng (Pinellia, Atractylodes Macrocephalae, and Gastrodia Decoction). I thought we’d drop a quick post on the formula, so here goes.
Formula composition
As can be seen, the formula, like Wēn Dǎn Tāng (Warm Gallbladder Decoction), is a variation on Èr Chén Tāng (Two Aged Decoction), with the addition of Bái Zhú and Tiān Má. The addition of Bái Zhú brings the formula close to an augmented Liù Jūn Zǐ Tāng (Six Gentlemen Decoction). In the graphic, the spleen supplementing ingredients are tinged yellow and are grouped to the right. As we’ll see later in the text, a modification for treating vacuity patterns by adding Rén Shēn (Rx Ginseng) completes the transformation to a modified Liù Jūn Zǐ Tāng. The inclusion of Tiān Má is the only ingredient focused on calming yáng and dispelling the wind attacking upward; the rest of the formula is focused on transforming phlegm, drying dampness, strengthening the spleen, and downbearing the stomach qì.
Background and text references
The formula was composed by Qīng era physician Chéng Guópéng (1662-1735) and published in his Yī Xué Xīn Wù which Scheid et al (2009) translate as Awakening of the Mind in Medical Studies. There is an earlier formula by the same name, in Lǐ Dōngyuán’s (1180-1251) Pí Wèi Lùn (Discussion of the Spleen and Stomach), but Chéng’s is the more commonly used prescription of the two.
The formula appears in two sections of the book, the first on headache and the second on dizziness. The formula as we know it today (and as depicted in the infographic) is primarily for dizziness due to phlegm inversion and is weaker for treating headache. But since my presentation focuses on acupuncture primarily with herbal medicine as an adjunct, commercially prepared formulas are highlighted rather than customized prescriptions.
頭痛
頭為諸陽之會，清陽不升，則邪氣乘之，致令頭痛。然有內傷、外感之異，外感風寒者，宜散之。熱邪傳入胃腑，熱氣上攻者，宜清之。直中證，寒氣上逼者，宜溫之。治法詳見傷寒門，茲不贅。然除正風寒外，復有偏頭風，雷頭風，客寒犯腦，胃火上衝，痰厥頭痛，大頭天行，破腦傷風，眉稜骨痛，眼眶痛等證。更有真頭痛，朝不保暮，勢更危急。皆宜細辨。
Headache
The head is the place where all yáng channels meet. If the clear yáng fails to ascend, evil qì will take advantage, causing headaches. However, internal damage and external contraction differ. In the case of external contraction of wind cold, one should disperse. In the case of heat evil spreading to the stomach fǔ and heat qì attacking upward, one should clear. In the case of a direct strike pattern, with forceful ascent of cold qì, one should warm. For treatment principles refer to the cold damage chapter, right now I won’t say anything more about it. But besides rectifying wind cold on the exterior, there is also one-sided head wind, thunder head wind, settling cold attacking the brain, upthrust of stomach fire, phlegm reversal headache, big head seasonal epidemic, brain-splitting wind damage, eyebrow bone pain, eye socket pain, and those sorts of patterns. Furthermore, there is true headache, in which the morning cannot guarantee the evening [i.e., which is very precarious], an even more critical situation. Each one should be carefully differentiated.
Chéng goes on to discuss the various formulas associated with each type of headache. The type for which Bàn Xià Bái Zhú Tiān Má Tāng is indicated is phlegm reversal headache:
痰厥頭痛者，胸膈多痰，動則眩暈，半夏白朮天麻湯主之。
In the case of phlegm reversal headache, there will be a profusion of phlegm in the chest and diaphragm, with stirring of dizziness and vertigo. Bàn Xià Bái Zhú Tiān Má Tāng is the ruling formula.
Down the page is the formula:
半夏白朮天麻湯
半夏（一錢五分） 白朮 天麻 陳皮 茯苓（各一錢） 甘草（炙，五分） 生薑（二片） 大棗（三個） 蔓荊子（一錢）
虛者，加人參。
水煎服。
Bàn Xià Bái Zhú Tiān Má Tāng
Bàn Xià (1 qián 5 fēn); Bái Zhú, Tiān Má, Chén Pí, Fú Líng (each 1 qián); Zhì Gān Cǎo (5 fēn); Shēng Jiāng (2 slices); Dà Zǎo (3 pieces); Màn Jīng Zǐ (Fr Viticis, 1 qián). If there is vacuity, add Rén Shēn (Rx Ginseng). Decoct in water and take.
Effectiveness for treating headaches
The addition of Màn Jīng Zǐ focuses this version of the formula on headache. Be that as it may, the standard formula as depicted in the graphic above, though considered more suitable for treating dizziness, is still used to treat headaches, as can be seen in the meta-analysis by Chen, et al. (2022). The meta-analysis of 19 studies focused on the use of Bàn Xià Bái Zhú Tiān Má Tāng in the treatment of migraines, and found that the use of the formula either alone or in combination with conventional medicine to be more effective than conventional medicine alone. The ingredients of the formula are given in the paper, and they are the same as Chéng’s standard formula in the graphic above.
‘Til next time
Okay, I need to get back to the patients and putting this course together. I will be back with more soon; as always, thanks for reading.
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
Chen, X., Liu, Z., Zhang, J., Chen, J. Qin, X., & Jiang, F. (2022). A meta-analysis of migraine treated with Banxia Baizhu Tianma decoction. Chinese Medicine and Natural Products, 2(3), e142-e151. DOI: https://doi.org/10.1055/s-0042-1757459
Chéng, G. (1732). Yī xué xīn wù. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E5%BF%83%E6%82%9F/index.html
Scheid, V., Bensky, D., Ellis, A., & Barolet, R. (2009). Chinese herbal medicine: Formulas & strategies (2nd ed.). Eastland Press.