Since I talked about the improper use of Jia Wei Xiao Yao San a few weeks ago, I thought it would be appropriate to focus on another highly misused formula: Yin Qiao San. For many practitioners, Yin Qiao San is the “go to” formula for common colds. It can be found on the shelves of many “natural” grocery stores and health food stores, and it is often marketed to the public as an herbal cold remedy. To find out why this formula is being used incorrectly, read on…
Yin Qiao San: we’ve all used it and recommended it to patients. Unfortunately, the formula is often improperly prescribed—at least when looked at from the perspective of the 温病 wēn bìng (warm disease) herbalists who originally created it. Quick…what’s the primary symptom to differentiate the use of Yin Qiao San from other formulas? Easy, right? It’s sore throat. Wrong. According to most Chinese medicine textbooks, the hallmark symptom of early stage wēn bìng is measurable fever (Liu, 2005; Maciocia, 2005; Deng, 2004)! That’s right: if you’re going to prescribe Yin Qiao San to a patient, you should take their temperature to confirm your diagnosis.
I became interested in the wēn bìng (warm disease) school while I was still a master’s level student because I felt that my herbal education in warm disease theory was lacking. Despite having classes in the Huang Di Nei Jing, Shang Han Lun, and Jin Gui Yao Lue—classes I was (and still am) extremely grateful for—I felt that I couldn’t make an informed decision about my own clinical practice if I did not explore all the major schools of Chinese herbalism. Since my herbal proclivities tended toward these Han dynasty texts, I was continually frustrated when certain clinical supervisors would force me to give Yin Qiao San to a patient simply because the symptomatology included sore throat. On several occasions, I had successfully treated myself for a cold (with accompanying sore throat) by using a formula from the Shang Han Lun, so I wanted to be sure a better alternative wasn’t available before suggesting Yin Qiao San to a patient. I decided that I would need to educate myself on the wēn bìng style of herbalism in order to properly argue my case, so I went online and ordered Warm Pathogen Diseases by Guohui Liu (2005).
The book was not an actual translation of the original wēn bìng literature, but rather a clinical textbook that focused on this particular school of herbalism. Among other things, I was intrigued to discover that the wēn bìng scholars were big fans of Zhang Ji (Zhang Zhong-jing), the author of the Shang Han Lun and Jin Gui Yao Lue. They created the wēn bìng formulas because they were not having success with Zhang’s classical formulas, and actually incorporated several Shang Han Lun formulas into their repertoire, including Bai Hu Tang and Ma Xing Shi Gan Tang.
As I began reading Liu’s textbook, my own suspicions about the clinical use of Yin Qiao San were vindicated, and I came to appreciate its clever composition. As mentioned above, a measurable fever is the hallmark symptom of early-stage wind-heat (Liu, p. 37). Other key diagnostic symptoms are slight chills and aversion to wind, cough, tongue with red tip and edges, and a floating, rapid pulse (Liu, p. 54). The patient may also present with headache, increased thirst, and sore throat (Liu, p. 198). Wu Tang (1758-1836), the herbalist who developed Yin Qiao San, had this to say about the treatment of disease:
“Use herbs that are as light as the feathers of a bird for disease in the upper burner; use herbs to lift the Spleen qi and cause the Stomach qi to descend in the middle burner, just like calibrating a scale that should always be in balance; and use heavy and cloying herbs to treat yin deficiency for the Liver and Kidney in the lower burner, like adding a heavy weight to a scale to tip the balance” (Liu, p. 22).
Many practitioners seem to use Yin Qiao San based on the pharmacological actions of the herbs that comprise it, so let’s examine the formula from this modern perspective:
Jin Yin Hua: antibiotic, anti-inflammatory, and antipyretic (Chen, p. 172); antiviral (Shang, 2011).
Lian Qiao: antibiotic, antiviral, anti-inflammatory, and antipyretic (Chen, p. 175).
Jie Geng: expectorant, anti-tussive, analgesic, and anti-inflammatory (Chen, p. 696).
Bo He: antipyretic and anti-inflammatory (Chen, p. 69).
Dan Zhu Ye: antipyretic (Chen, p. 120).
Jing Jie: antibiotic, antipyretic, and analgesic (Chen, p. 50).
Dan Dou Chi: mild diaphoretic (Chen, p. 90).
Niu Bang Zi: antibiotic, anti-inflammatory, and antipyretic (Chen, p. 71).
Lu Gen: mild sedative effect (Chen, p. 118).
Gan Cao: anti-inflammatory, increases phagocytosis, anti-tussive, expectorant, and antibiotic. (Chen, p. 869-870).
Looking at these modern pharmacological indications, one can see why many practitioners are fond of this formula: it reduces fever, stops coughing, reduces inflammation, stimulates the immune system, and inhibits viruses. Unfortunately, using Yin Qiao San based solely on a pharmacological basis is tantamount to practicing biomedicine with Chinese herbs. If we ignore the methods of Chinese medicine (inquiry, observation, tongue/pulse diagnosis, etc.) we may miss an opportunity to use a more effective formula, and we fail to offer our patients a truly “alternative” medicine. Now let’s take a look at the ingredients of Yin Qiao San from the perspective of their traditional Chinese medicine actions:
Jin Yin Hua: a light herb that clears heat and relieves toxicity (Bensky & Barolet, p. 45; Bensky, Clavey, & Stoger, p. 149); vents and disperses wind-heat (Bensky, Clavey, & Stoger, p. 149).
Lian Qiao: a light herb that clears heat and relieves toxicity (Bensky & Barolet, p. 45; Bensky, Clavey, & Stoger, p. 153); used with Jin Yin Hua to treat the early stages of a wind-heat invasion (Bensky, Clavey, & Stoger, p. 253).
Jie Geng: spreads/disseminates Lung qi (Bensky & Barolet, p. 45; Liu, p. 200; Bensky, Clavey, & Stoger, p. 429); alleviates sore throat in conjunction with Gan Cao (Bensky & Barolet, p. 45; Mitchell, Ye, & Wiseman, p. 518; Bensky, Clavey, & Stoger, p. 733).
Bo He: releases the exterior (Liu, p. 200); disperses wind-heat (Bensky, Clavey, & Stoger, p. 47; Bensky & Barolet, p. 45).
Dan Zhu Ye: clears heat (Liu, p. 200; Bensky, Clavey, & Stoger, p. 98); generates fluids and alleviates thirst (Bensky & Barolet, p. 45).
Jing Jie: releases the exterior (Bensky, Clavey, & Stoger, p. 14; Liu, p. 200).
Dan Dou Chi: releases the exterior (Liu, p. 200; Bensky, Clavey, & Stoger, p. 64); releases exterior heat (Bensky & Barolet, p. 45)
Niu Bang Zi: disseminates Lung qi (Liu, p. 200; Bensky & Barolet, p. 45); disperses wind-heat (Bensky, Clavey, & Stoger, p. 50); benefits the throat (Bensky, Clavey, & Stoger, p. 50; Bensky & Barolet, p. 45).
Lu Gen: generates fluids and alleviates thirst (Liu, p. 200; Bensky & Barolet, p. 45; Bensky, Clavey, & Stoger, p. 106); clears heat (Bensky, Clavey, & Stoger, p. 106).
Gan Cao: alleviates sore throat in conjunction with Jie Geng (Bensky & Barolet, p. 45; Mitchell, Ye, & Wiseman, p. 518; Bensky, Clavey, & Stoger, p. 733); disseminates Lung qi (Liu, p. 200); moistens the Lungs and stops cough (Bensky, Clavey, & Stoger, p. 732).
As an herbalist, it’s hard not to marvel at the brilliance of this formula’s composition. Even dedicated Shang Han Lun scholars would have to agree that this is an artfully crafted formula. Yin Qiao San is a beautiful example of Chinese herbal theory, and Wu Tang brilliantly uses herb combinations to maximize its effect. Several of the herbs release the exterior, while light clear-heat and toxin herbs lead the pathogen up and out of the body; other herbs alleviate the sore throat and thirst that frequently accompany early-stage wind-heat invasions.
There are some interesting notes in Guohui Liu’s book about the proper preparation of Yin Qiao San. Originally, the juice of fresh Lu Gen was added to the other herbs—most, if not all, modern preparations use the dry form of Lu Gen. The herbs should also be ground into a powder, and then soaked in cold water for 30 minutes in the decocting vessel; the decoction should be brought to a boil using a high flame for approximately eight minutes, or until the fragrance of the herbs fills the air (Liu, p. 202). If the formula is cooked too long, the “light nature and acrid flavor,” of the herbs “will be leached out with the steam, and only the bitter flavor will remain” (Liu, p. 202). In modern terms, this specific indication preserves the volatile aromatic oils in herbs like Bo He and Jing Jie.
Gaohui Liu recommends the following dosages of the bulk herb decoction:
Adults: one-half cup six times a day
Children: three to five spoonfuls six times a day
Infants: two to three spoonfuls six times a day
—(Liu, p. 203)
When properly prescribed, Yin Qiao San is an incredibly effective remedy for early-stage wind-heat. It is a beautifully crafted formula, which is supported by—not based on—the pharmacological constituents of its herbs. Compare this to a formula like Gan Mao Ling: a modern preparation for colds that is based purely on the pharmacological constituents of its herbs and “is at direct odds with Chinese medicine’s fundamental theory” (Blalack & Rosenberg, 2012). I’ve run a little long with this article, so I’m going to save my favorite alternatives to Yin Qiao San for the next one…
Dan Bensky & Randall Barolet, (1990). Formulas & Strategies
Dan Bensky, Steven Clavey, & Erich Stoger, (2004). Materia Medica, 3rd Edition
Jason Blalack & Z’ev Rosenberg, (2012). Gan Mao Ling and Studying the Classics
John and Tina Chen, (2004). Chinese Medical Herbology and Pharmacology
Tietao Deng, (2004). Practical Diagnosis in Traditional Chinese Medicine
Guohui Liu, (2005). Warm Pathogen Diseases
Giovanni Macciocia, (2005). The Foundations of Chinese Medicine
Craig Mitchell, Feng Ye, Nigel Wiseman, (1999). Shang Han Lun
Shang, Pan, Li, Miao, & Ding, (2011). Lonicera japonica Thunb.: ethnopharmacology, phytochemistry and pharmacology of an important traditional Chinese medicine.
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