Huan Wang Xin Quan LiHong Guo

Abstract: purpose Research on the applications of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat difficult cases. Methods: Summarizing Professor Wang Sanhu’s experience using Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat difficult cases by observational learning and organizing case reports. Results: Professor Wang Sanhu utilizes the refined combination and wide applications of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat a wide variety of diseases effectively in clinical practice. Conclusion: Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) clears heat while nourishing yin and cools the blood while dissipating stasis. It has a reliable therapeutic effect on diseases with pattern diagnoses of heat entering the blood aspect.

Keywords：Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng), difficult cases, Wang Sanhu

Among the more than 6500 formulas in Qianjin Fang ［Thousand Gold Pieces Formulary］, Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) is one of the most iconic. It comes from volume 12, chapter 6 (entitled “Blood Ejection”) of Beiji Qianjin Yaofang ［A Thousand Gold Pieces Emergency Formulary］, which states: “To treat ［cases of］ cold damage and warm disease ［in which］ sweating should have been promoted but was not, ［with］ internal blood amassment as well as nosebleed, incessant blood ejection, internal excess of static blood, black stool, and a yellow face, ［use this］ blood stasis-dispersing formula.” The original formula consists of 1 liang of rhinoceros horn (xī jiǎo), 2 liang of dried rehmannia root (gān dì huáng), 3 liang of peony root (sháo yào), and 2 liang of moutan root bark (dān pí). With actions of clearing heat, resolving toxin, cooling blood, and dissipating stasis, this formula is commonly used to treat heat entering the blood aspect in warm disease. It is indicated in cases of heat entering the blood aspect with delirious speech and macular eruption, as well as blood ejection, nosebleed, bloody stool, and bloody urine due to heat damaging the blood network vessels. “The prescription’s rhinoceros horn (buffalo horn) is the main medicine for clearing heat, cooling blood, and detoxifying. The prescription’s rhinoceros horn (buffalo horn) is the main medicine for clearing heat, cooling blood, and detoxifying. In this formula, fresh rehmannia root (shēng dì) clears heat, cools blood, and nourishes yin humor in its role as minister. Peony root (sháo yào) harmonizes construction and discharges heat, while moutan root bark (dān pí) discharges latent heat in the blood aspect, cools blood, and disperses stasis; they serve as assistant and envoy respectively. The combination of these 4 medicinals is precise and appropriate, cleverly resolving the conflicts between cooling and quickening blood, as well as stopping bleeding and dispersing stasis. Because it clears heat while nourishing yin and cools the blood while dissipating stasis, allowing the heat to be cleared and bleeding to stop without the drawback of lingering stasis, it is a key formula for treating heat entering the blood aspect.”^［1］

Professor Wang Sanhu, the foremost tumor expert at Shaanxi Provincial Hospital of Chinese Medicine in the city of Xi’an, has extensive experience using Qianjin Fang ［Thousand Gold Pieces Formulary］to treat difficult cases^［2,3,4］and Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) is one of the formulas he uses most frequently. Professor Wang Sanhu utilizes the refined combination and wide applications of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat a wide variety of diseases effectively in clinical practice. A portion of his experience is described below:

Psoriasis

Psoriasis, also known as “oxhide lichen”, is a chronic skin disease characterized by redness and scaling that has a tendency to recur. It is the same as “white crust”, “pine bark lichen”, and “dry lichen” in TCM theory. Professor Wang Sanhu views psoriasis from the perspective of heat toxin in the blood, and primarily uses variant formulas of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng). He uses 30 grams of water buffalo horn (shuǐ niú jiǎo) as a substitute for rhinoceros horn (xī jiǎo) in the formula, along with 30 grams of fresh rehmannia root (shēng dì) and 12 grams each of red peony root (chì sháo) and moutan root bark (dān pí). He often adds coptis root (huáng lián) and scutellaria root (huáng qín) to strengthen the formula’s ability to clear heat, drain fire, cool blood, and resolve toxin, as well as arnebia/lithospermum (zǐ cǎo) and isatis leaf (dà qīng yè) to enhance its blood-cooling and blood-quickening effects. Thus, he has created a basic formula for treating psoriasis: water buffalo horn (shuǐ niú jiǎo) 30 g, fresh rehmannia root (shēng dì)30 g, moutan root bark (dān pí) 12 g, red peony root (chì sháo) 12 g, arnebia/lithospermum (zǐ cǎo) 15 g, forsythia fruit (lián qiào) 15 g, sophora flower (huái huā) 15 g, scutellaria root (huáng qín) 12 g, saposhnikovia root (fáng fēng) 10 g, ligustrum fruit (nǚ zhēn zǐ) 12 g, eclipta (hàn lián cǎo) 12 g, licorice root (gān cǎo) 12 g, mulberry root bark (sāng bái pí) 12 g, tribulus fruit (jí lí) 30 g, cicada molting (chán tuì) 12 g, anemarrhena root (zhī mǔ) 12 g, and gypsum (shí gāo) 30 g. For cases with invasion of the stomach by liver qi or liver-stomach disharmony, he adds dandelion (pǔ gōng yīng) and forsythia fruit (lián qiào), which act to course the liver and harmonize the stomach in addition to clearing heat and resolving toxin. If there is thirst with liking for fluids and dry bound stool, he adds 30 to 60 grams of raw gypsum (shēng shí gāo). If there is damp heat in the lower burner, he adds phellodendron (huáng bǎi), flavescent sophora root (kǔ shēn), and sophora flower (huái huā). If there is stasis, he adds carthamus flower (hóng huā), salvia root (dān shēn), spatholobus stem (jī xué téng), and peach kernel (táo rén). If there is dampness, he combines the formula with Stomach-Calming Powder (píng wèi sǎn) and adds smooth greenbrier root (tǔ fú líng) and coix seed (yì rén). If there is phlegm, he adds pinellia rhizome (bàn xià), white mustard seed (bái jiè zǐ), and poria (fú líng). For cases with severe itching, he adds tribulus fruit (cì jí lí), silkworm (bái jiāng cán), kochia fruit (dì fū zǐ), and purslane (mǎ chǐ xiàn). If the face is primarily affected, dahurian angelica (bái zhǐ) and dictamnus bark (bái xiān pí) may be added. If the skin lesions are dark purple, he adds arnebia/lithospermum (zǐ cǎo) and isatis leaf (dà qīng yè). If the skin damage takes a long time to heal, he adds mume fruit (wū méi) or pomegranate rind (shí liú pí).

Professor Wang Sanhu has used Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to successfully treat many cases of psoriasis, not all of which will be listed here. In September 2017, Professor Wang Sanhu was invited to teach in Australia, where he lectured on psoriasis. In October 2017, a student in Australia sent feedback via WeChat after getting good results using Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) to treat psoriasis: “Professor Wang, I listened to your class and used your formula, and it was really effective. For example, there was a female patient in her fifties who had suffered from oxhide lichen for over 30 years. She had skin lesions in multiple areas with itching and discomfort, and her skin was dry and flaky. When she left after the first visit, my red floor was covered in white ‘snow’ and I had to change everything on the table. By the second visit, the patient’s mental state had greatly improved. At the third visit, I asked the patient to follow a vegetarian diet. By the fourth visit, there was no itching and no more ‘snow’. I used scrophularia root (xuán shēn) instead of water buffalo horn (shuǐ niú jiǎo), and I only used one-third of the dose for all of the medicinals.”

Note：Professor Wang Sanhu believes that the formation of psoriasis has an important relationship with excessive mental stress, depression and anger with inflexibility, liver and gallbladder depression and stagnation, and lesser yang wind-fire. Therefore, in clinical practice, if there is depressed mood or sighing, or if he learns that the patient suffers from mental stress or other circumstances in the course of the intake, he adds Minor Bupleurum Decoction (xiǎo chái hú tāng) to the formula.

A case of encephalopathy after carbon monoxide poisoning

The patient, Ms. Ma, was a 52-year-old female from Heyang County in Shaanxi. On April 3, 2013, she came in for her first visit for gas poisoning. She had a headache and brain fog, and needed to be accompanied by a caregiver. Her face was red as if she was wearing makeup. Her electroencephalogram showed hypoxic-ischemic brain changes. Her tongue was red with yellow fur, and her pulse was stringlike and rapid. The pattern diagnosis was heat-toxin in the blood and phlegm clouding the clear orifices. The treatment was to clear heat, cool the blood, resolve toxin, transform phlegm, and open the orifices using a variation of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) and Gallbladder-Warming Decoction (wēn dǎn tāng) (granules): 1 packet each of water buffalo horn (shuǐ niú jiǎo), rehmannia root (dì huáng), moutan root bark (dān pí), red peony root (chì sháo), acorus root (shí chāng pú), polygala root (yuǎn zhì), gardenia fruit (zhì zǐ), pro formula pinellia rhizome (fǎ bàn xià), poria (fú líng), tangerine peel (chén pí), unripe bitter orange (zhǐ shí), trichosanthes fruit (guā lóu), chuanxiong rhizome (chuān xiōng), gastrodia root (tiān má), white atractylodes root (bái zhú), white peony root (bái sháo), juncus pith (dēng xīn cǎo), and lotus leaf (hé yè), for a total of 30 preparations, 1 preparation a day, to be dissolved in boiling water and divided into 2 doses to be taken separately. On May 1, 2013, she visited the clinic again and reported that her symptoms had lessened. She continued to take the same formula for 2 months, and on August 7, 2013, she came to the clinic by herself and her appearance was normal. She had occasional headaches, a red tongue, and a stringlike pulse. She was given 30 more preparations of the same formula.

Note: Professor Wang Sanhu has gradually summarized his experience in the course of treating multiple cases. Early on, he believed that the pathomechanism was phlegm-heat harassing the heart, so he used Gallbladder-Warming Decoction (wēn dǎn tāng) variant formulas to clear heat, transform phlegm, and quiet the heart. Later, in practice, he discovered that blood-heat turning into toxin was also an important pathomechanism.^［5］ This gave him the idea to use Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng) combined with Gallbladder-Warming Decoction (wēn dǎn tāng) to treat encephalopathy caused by carbon monoxide poisoning. He used a complex prescription for a complex case; his experience using combinations of formulas to treat difficult diseases is significant.

A case of aplastic anemia

The patient, Ms. Ju, was a 56-year-old married female cadre from Honghai Village in Bachu County, Xinjiang. She came for treatment on December 25, 2002.

In September 2002, the patient started to feel unwell for no apparent reason, with lack of strength and low appetite. After 1 week, her lack of strength worsened; she felt flustered and short of breath, with tremors in her limbs. She was admitted to the Bachu County hospital, where she was treated for anemia. Her condition worsened, so she was quickly transferred to the 12th Hospital of the People’s Liberation Army in the city of Kashi ［or Kashgar］. Based on her clinical presentation and peripheral blood smear, she was diagnosed with “acute aplastic anemia” and was given stanozolol, prednisone acetate, and cyclosporine. After undergoing nearly 3 months of treatment, requiring 1 blood transfusion every week, she came to the Cancer Research Institute at the Fourth Military Medical University ［now the Air Force Medical University］ in Xi’an.

At the initial intake, the patient had a lusterless facial complexion, with somber white lips and tongue. She was fatigued and her whole body was covered with maculopapular eruptions that were dark purple in color, some as large as a penny and others as small as a sesame seed, which were mainly concentrated on her chest. She felt sharp pain in her chest like being stabbed with a needle, along with tremors in her limbs, heart vexation, dry mouth, lumbar pain, limp legs, a crimson tongue, and a rapid pulse. Her disease was classified as vacuity consumption and the pattern diagnosis was toxic heat entering the blood, marrow depletion with desiccation of essence, and dual vacuity of qi and blood. The treatment methods were to cool and dissipate blood, stanch bleeding, and resolve toxin, along with supplementing blood, replenishing essence, and boosting qi. The formula used was a variation of Rhinoceros Horn and Rehmannia Decoction (xī jiǎo dì huáng tāng): water buffalo horn (shuǐ niú jiǎo) 30 g, fresh rehmannia root (shēng dì) 30 g, white peony root (bái sháo) 12 g, moutan root bark (dān pí) 12 g, arnebia/lithospermum (zǐ cǎo) 15 g, sophora flower (huái huā) 10 g, eclipta (hàn lián cǎo) 12 g, notoginseng root (sān qī) 5g (to be taken drenched), cooked rehmannia root (shú dì) 20 g, ass hide glue (ē jiāo) 10 g (melted), tortoise shell (guī bǎn) 12 g, cornus fruit (shān yú ròu) 12 g, and mix-fried astragalus root (zhì huáng qí) 40 g. One preparation was to be taken daily, decocted with water. The patient returned on January 10, 2003, after continuously taking 12 preparations of the above formula. She felt that her energy had increased and the bleeding spots on her skin had gradually disappeared. She had a low-grade fever at night, and while her tongue body was dark, it was lighter than it was before. Her pulse was rapid. This was caused by a gradual decrease in heat toxin with effulgent yin vacuity fire. The plan was to build on the foundation of clearing heat, resolving toxin, cooling blood, stanching bleeding, quickening the blood, transforming stasis, supplementing the kidneys, and replenishing marrow by adding medicinals that clear vacuity heat, using the following formula: water buffalo horn (shuǐ niú jiǎo) 30 g, fresh rehmannia root (shēng dì) 30 g, red peony root (chì sháo) 12 g, moutan root bark (dān pí) 12 g, arnebia/lithospermum (zǐ cǎo) 12 g, tortoise shell (guī bǎn) 12 g, cooked rehmannia root (shú dì) 30 g, cornus fruit (shān yú ròu) 12 g, ligustrum fruit (nǚ zhēn zǐ) 12 g, eclipta (hàn lián cǎo) 12 g, mulberry (sāng shèn) 12 g, ass hide glue (ē jiāo) 10 g, stellaria (yín chái hú) 12 g, lycium bark (dì gǔ pí) 12 g, scrophularia root (yuán shēn) 12 g, black swallowwort (bái wēi) 12 g, scutellaria root (huáng qín) 10 g, agrimony (xiān hè cǎo) 10 g, and flowery knotweed root (hé shǒu wū) 12 g. Variant: for convulsions of the hands and feet, add 12 g of gastrodia root (tiān má), 12 g of white peony root (bái sháo), 6 g of licorice root (shēng cǎo), 10 g of chaenomeles fruit (mù guā), and 30 g each of crude dragon bone and oyster shell (shēng lóng mǔ). One preparation was to be taken daily, decocted with water. The patient’s third visit was on March 6, 2003. She had continuously taken 30 preparations of the formula given above and felt that her symptoms had lessened. She had only 2 blood transfusions in February and the dose of her western medications had been gradually reduced due to the side effects.

Note: Aplastic anemia is considered a difficult disease for which modern medicine has not yet found a specific treatment. The success of this case lies in the fact that, from the initial observation of heat toxin entering the blood to the later stage presenting with kidney yang depletion, the treatment always targeted the essential nature of vacuity consumption, which is “marrow depletion with desiccation of essence, and dual vacuity of qi and blood”, and focused on the relationships among mutual transformation of essence and blood, mutual engendering of qi and blood, and yin growing when yang arises. Particular attention was paid to the application of focused and powerful medicinals with affinity to flesh and blood. This shows that TCM is not limited to pattern diagnosis, but also emphasizes the identification of diseases. Only when the disease has been clearly identified can one have a proactive, comprehensive, and in-depth grasp of the occurrence and development of a disease, as well as the changes in the pattern.

Author information:

Wang Huan, Xi’an Traditional Chinese Medicine Hospital, Shaanxi Province

Quan Xinkong, Xi Jing Hospital

References

1. Wang Sanhu, Zhang Zhonghai, Wang Changhai et al., eds. 120 shou Qianjin Fang yanjiu ［Research on 120 formulas from Thousand Gold Pieces Formulary］［S］. Shaanxi sheng kexue jishu chubanshe ［Shaanxi Science and Technology Press］, 1997:177.

2. Zhang Ruonan, Wang Xing. Wang Sanhu yingyong Qianjin Fang zhiliao aizheng jingyan ［Wang Sanhu’s experience applying Thousand Gold Pieces Formulary to treat cancer］［J］. Zhongyi zazhi ［Journal of traditional Chinese medicine］, 2004, 45(3):176-177.

3. Liu Xiaochao, Li Ling. Wang Sanhu jiaoshou zhiliao nao zhongliu de jingyan ［Professor Wang Sanhu’s experience treating brain tumors］［J］. Zhongguo minzu minjian yiyao ［Chinese journal of ethnomedicine and ethnopharmacy］, 2009, 18(8):52-53.

4. Qi Tao, Wang Huan. Wang Sanhu zhiliao xueguanliu jingyan ［Wang Sanhu’s experience treating angioma］［J］. Zhongguo zhongyiyao xinxi zazhi ［Chinese journal of information on traditional Chinese medicine］, 2009, 16(6):83.

5. Wang Sanhu. Zhongyiyao zhiliao yiyanghuatan zhongdu chifaxing naobing 2 li ［Treating 2 cases of delayed encephalopathy from carbon monoxide poisoning with Chinese medicine］［N］. Zhongguo zhongyiyao bao ［Chinese journal of Chinese medicine］, 2003-8-11 (6).