In my recent article, “Fool’s Cold: The Improper Use of Yin Qiao San,” I promised to share some of my favorite formulas for treating the common cold. This is part two of a series of articles dedicated to that topic. You will note that many of the formulas I share are from Kan Herb Company. As mentioned in part one of this series, I used to work at Kan as an herbal consultant, so I am very familiar with their formulas, and I know the level of quality-control they put into their products (including testing for heavy metals, microbes, and pesticides). While I have yet to be impressed with teapills or tablets from any company, I have found Kan’s liquid extracts to be quite potent.
Gui Zhi Tang
In the previous article, we examined the clinical use of Jing Fang Bai Du San for common colds presenting as wind-cold-damp. What if your patient presents with a classic case of wind-cold? The Huang Di Nei Jing Su Wen (Chapter 19) states: “When wind and cold settle in a person…the skin closes and develops heat. At this time, [the wind and the cold] can be effused through [induced] sweating” (Unschuld, p. 337). Chapter 18 of the Huang Di Nei Jing Ling Shu says: “When the exterior is injured by wind, the interior is opened at the pores..and the body fluids leak from the interior” (Wu, p. 91). These two statements sum up the patho-mechanisms of cold-damage and wind-strike, respectively—the primary exterior wind-cold patterns discussed in the Shang Han Lun. When the Tai Yang is affected, practitioners have a choice between Ma Huang Tang (for cold-damage) and Gui Zhi Tang (for wind-strike), but due to the current FDA status of Ma Huang, I will limit my analysis to Gui Zhi Tang alone. Kan offers Gui Zhi Tang as “Cinnamon Twig Decoction”, and Plum Flower calls it “Gui Zhi Teapills”.
Gui Zhi Tang is indicated for chills and fever unrelieved by sweating, headache, aversion to wind, stiff neck, nasal congestion, dry heaves, and no particular thirst (Bensky & Barolet, p. 35). The tongue will have a thin white and moist coat, and the pulse will be floating and moderate or floating and frail (Bensky & Barolet, p. 35). First mentioned in the Shang Han Lun, Gui Zhi Tang is primarily used to readjust the balance between the yíng qi and the wèi qi. In the body, yíng qi and wèi qi represent an important yin-yang pairing. Elisabeth Rochat de la Vallee suggests that yíng (營) “might mean to establish a military camp…[or] to rebuild or reconstruct,” and that wèi (衛) means “defense…made with a kind of circulation and a regulation of movement” (Larre & Rochat de la Valle, p. 62-63). According to the Huang Di Nei Jing Su Wen (Chapter 43):
“The camp [qi] (yíng qi), that is the essence qi of water and grain. When it is harmoniously balanced in the five depots, and when it is dispersed throughout the six palaces, then it can enter the vessels. Hence, it follows the vessels upwards and downwards, penetrates the five depots and connects the six palaces.
The guard qi (wèi qi), that is the violent qi of water and grain. This qi is fast and unrestrained and cannot enter the vessels. Hence, it moves inside the skin and in the partings of the flesh…
<To oppose this qi, results in disease. To follow this qi, results in healing>” (Unschuld, p. 649).
This statement is echoed again in the Nei Jing Ling Shu (Chapter 18): “The clear qi is the [yíng] qi; the muddy qi is the [wèi] qi. The [yíng] qi is located in the middle of the channels; the [wèi] qi is located outside of the channels” (Wu, p. 90). Due to their relative locations on the exterior and interior of the channels, the wèi qi represents a form of yang qi, and the yíng qi represents a form of yin qi in the body. The dynamic yin-yang activity of Gui Zhi Tang is achieved by the two primary herbs: Gui Zhi and Bai Shao. In this potent pairing, Gui Zhi is yang with its warm, acrid, opening, and outward moving nature; and Bai Shao is yin with its cool, sour, nourishing, and restraining nature.
Let’s take a look at the herbs in Gui Zhi Tang from a Chinese medicine perspective (herbs that the Kan formula omits are marked with an asterisk and herbs that the formula adds are in parentheses):
Gui Zhi: releases externally contracted wind-cold (Benksy & Barolet, p. 36); transforms thin mucous (Bensky, Clavey, & Stoger, p. 9); when used in combination with Bai Shao, “one effects the qi and one effects the blood; one disperses, the other restrains; one is moving, the other is still” (Bensky, Clavey, & Stoger, p. 10).
Bai Shao: benefits the yin and strengthens the yíng qi (Bensky & Barolet, p. 36); preserves the yin and adjusts the yíng and wèi qi (Bensky, Clavey, & Stoger, p. 755); when used in combination with Gui Zhi, “one effects the qi and one effects the blood; one disperses, the other restrains; one is moving, the other is still” (Bensky, Clavey, & Stoger, p. 10).
[Take note of the actions of Gui Zhi and Bai Shao: they constitute a beautiful yin-yang herb pair!]
Sheng Jiang *: releases the exterior and treats nausea (Bensky & Barolet, p. 36); warms the middle burner, releases the exterior and disperses cold (Bensky, Clavey, & Stoger, p. 31).
(Gan Jiang): warms the middle and expels cold (Bensky, Clavey, & Stoger, p. 682); warms the Lungs and transforms thin mucous (ibid).
Da Zao: nourishes and harmonizes the yíng qi and blood, tonifies the middle, and harmonizes the other herbs (Bensky & Barolet, p. 36)
Zhi Gan Cao: tonifies the middle and harmonizes the other herbs (Bensky & Barolet, p. 36); moistens the Lungs and stops cough, and tonifies the Spleen qi (Bensky, Clavey, & Stoger, p. 733).
At its core, Gui Zhi Tang is a formula that readjusts the balance of yin-yang within the body while simultaneously supporting the middle burner. Why is it important to support the middle burner in cases of external invasion? The Systematic Classic of Acupuncture and Moxibustion (Jia Yi Jing) states, “The [yíng qi] issues from the middle burner. The [wèi qi] issues from the upper burner” (Yang & Chase, p. 18). Thus, by supporting the qi of the middle burner, the yíng qi—which has been flowing out as sweat via the pores—is renewed and strengthened. In this artfully simple, yet effective formula, one group of herbs (Sheng Jiang, Da Zao, and Zhi Gan Cao) supports the middle, while the other (Gui Zhi and Bai Shao) readjusts the yíng-wèi dynamic to restore harmony and order to the body. It should be noted that the Shang Han Lun suggests taking this decoction along with hot rice gruel, and then wrapping up in a blanket until a light sweat is achieved (Mitchell, Ye, & Wiseman, p. 62).
Now let’s look at the composition of Gui Zhi Tang from the perspective of the pharmacological actions of the herbs:
Gui Zhi: antibiotic, anti-viral, diaphoretic, antipyretic, anti-tussive, analgesic (Chen, p. 42); anti-inflammatory and antimicrobial (Rao, 2014).
Bai Shao: antibiotic, antipyretic, and anti-inflammatory (Chen, p. 932); anti-inflammatory and immuno-modulatory (He, 2011); antiviral (Ho, 2014).
Sheng Jiang *: antibiotic (Chen, p. 46); antiviral (Chang, 2013).
(Gan Jiang): regulates body temperature (Chen, p. 451); anti-inflammatory (Choi, 2013)
Da Zao: antimicrobial (Daneshmand, 2013).
Zhi Gan Cao: anti-inflammatory, increases phagocytosis, anti-tussive, expectorant, and antibiotic. (Chen, p. 869-870).
As you can clearly see, even a classical formula like Gui Zhi Tang has pharmacological effects relevant to the treatment of common cold. So, there is no reason to utilize a wind-heat formula like Yin Qiao San—or a modern anti-viral concoction like Gan Mao Ling—to treat wind-cold, simply because of the phytochemical constituents of the herbs contained in these preparations. It is important that practitioners continue to practice Chinese herbalism based on the theories of Chinese medicine—as opposed to practicing biomedicine with Chinese herbs!
References:
Dan Bensky & Randall Barolet, (1990). Chinese Herbal Medicine: Formulas & Strategies.
Dan Bensky, Steven Clavey, & Erich Stoger, (2004). Chinese Herbal Medicine: Materia Medica, 3rd Edition.
JS Chang, et. al., (2013). Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines.
John & Tina Chen, (2004). Chinese Medical Herbology & Pharmacology.
YY Choi, et. al. (2013). Dried Ginger (Zingiber officinalis) Inhibits Inflammation in a Lipopolysaccharide-Induced Mouse Model.
F. Daneshmand, H. Zare-Zardini, & T. Ghanbari, (2013). Crude Extract from Zizphus Jujuba Fruits, a Weapon Against Pediatric Infectious Disease.
Dong-Yi He & Sheng-Ming Dai, (2011). Anti-Inflammatory and Immunomodulatory Effects of Paeonia Lactiflora Pall., a Traditional Chinese Herbal Medicine.
Jin-Yuan Ho, Hui-Wen Chang, & Jim-Tong Horng, (2014). Characterization of the Anti-Influenza Activity of the Chinese Herbal Plant Pawonia lactiflora.
Claude Larre & Elisabeth Rochat de la Vallee, (1996). Essence, Spirit, Blood and Qi.
Craig Mitchell, Feng Ye, & Nigel Wiseman, (1999). Shang Han Lun.
Pasupuleti Visweswara Rao & Siew Hua Gan, (2014). Cinnamon: A Multifaceted Plant.
Paul Unschuld, (2011). Huang Di Nei Jing Su Wen: An Annotated Translation.
Jing-Nuan Wu, (1993). Ling Shu or The Spiritual Pivot.
Shou-Zhong Yang & Charles Chace, (2004). The Systematic Classic of Acupuncture and Moxibustion.
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