Eichas, Bing Yang
Massachusetts College of Pharmacy and Health Sciences
New England School of Acupuncture
The Treatise of Cold Damage Disease, or the Shang Hun Lun, serves as the foundation of the basis of Chinese Materia Medica. Written by Zhang Zhong Jing in the Han Dynasty, herbal formulas and treatment strategies are introduced to treat patients inflicted with disease from a cold pathogen attacking one or more various levels in the human body. Pinellia Decoction to Drain the Epigastrium, Ban Xia Xie Xin Tang (BXXXT) has many clinical applications. Classified as a Traditional Chinese Medicine formula in the Formulas that Harmonizes the Stomach and Intestines, BXXXT benefits patients suffering from gastrointestinal disorders. In the lens of Traditional Chinese Medicine, a patient with simultaneous excess (usually phlegm or damp accumulation) and deficiency (impaired function of the Middle Burner now further deteriorating due to phlegm and damp) causing gastrointestinal stagnation and accumulation and a scenario of “clumping of cold and heat” benefits from the restoration of the qi mechanism and the balance of Yin and Yang. While classically attributed to inappropriate purging that has driven a Tai Yang cold pathogen deeper into the interior, invading the Stomach, and disrupting the Spleen qi mechanism, modern patients in today’s clinic often lead busy lifestyles, take their meals or eat “on the go”, or consume a poor diet that contributes to this condition.
The chief Huang Lian is bitter (able to drain downward), and cold (able to cool heat) and is especially effective in the Middle Burner and epigastric area. The deputy Huang Qin has the same characteristics as the chief and provides reinforcement for these actions. These ingredients are balanced by the other deputies (Zhi) Ban Xia and Gan Jiang which provide the warming function that allows a favorable environment for the Middle Burner. Ban Xia is both acrid (dispersing for clumped and accumulation) and warming, can treat nausea and distention. Gan Jiang is very warming (benefitting the Spleen and Stomach) and also acrid, reinforcing the actions of Zhi Ban Xia. The assistants Ren Shen and Da Zao can tonify the Middle Burner, protect the patient’s qi from some of the harsher properties of the chief and deputies, as well as treat nausea. The envoy Zhi Gan Cao harmonizes the Middle Burner and the other herbs in this formula. With the restoration of the qi dynamic, the Spleen is strengthened, and the damp heat is cleared.
Clinical indications for BXXXT per Scheid & Bensky, 2015 include “focal distention” or pi syndrome – “A focused, localized sensation of discomfort, blockage, and distention centered on the epigastrium” or conditions “whenever the ascending and downward-directing functions of the Spleen and Stomach are disturbed by the presence of dampness or phlegm constraining the middle burner yang”. (p. 128). Patients in the clinic often report subjective epigastric discomfort or fullness yet present with no appreciable hardness/bulging/swelling during provider palpatory assessment. In today’s present-day clinic, patients will report various symptoms classified as “Functional Dyspepsia”, a term used to encompass and include what Talley et al., 1999 describe as “persistent or recurrent pain or discomfort centered in the upper abdomen; evidence of organic disease likely to explain the symptoms is absent, including at upper endoscopy. Discomfort refers to a subjective, negative feeling that may be characterized by or associated with a number of non-painful symptoms including upper abdominal fullness, early satiety, bloating, or nausea”.
BXXXT has clinical uses in the modern-day clinic in patients suffering from gastrointestinal discomfort and pathology. Gao et al., 2024 find that using this formula to combat gastric inflammation (commonly from H. Pylori infection) in patients suffering from chronic atrophic gastritis. Chronic atrophic gastritis may be a precursor to gastric cancer in up to almost 30% of newly diagnosed gastric cancer cases in China. H.Pylori is also commonly associated with peptic and gastric ulcers. BXXXT alone or combined with other Western medications has been used with more clinical success for patients with FD, Functional Dyspepsia, in patients being treated with Western medicine (Kim et al., 2023). Per Kang et al., 2018, BXXXT is indicated for “promoting gastrointestinal peristalsis, preventing reflux, protecting the gastric mucosa, invigorating the immune system, and improving the body’s ability to resist hypoxia. BXT was mainly used to treat illnesses of the digestive system, such as reflux oesophagitis, acute and chronic gastritis, peptic ulcer, dyspepsia, and constipation.”
Modifications can be made to BXXXT to further improve clinical outcomes. As previously noted, BXXXT in conjunction with Western medications have been more effective for treatment of FD. Scheid & Bensky, 2015 note that modern decoction differs from traditional dosing as the dose of Zhi Ban Xia increases by 3g (9-12g total) and decreasing doses of Zhi Gan Cao and Da Zao (12 pieces to 4 pieces) to further protect the Middle Burner and preventing abdominal distention. Patients would likely benefit from adapting what Mclean et al., 2018 refer to as a diet favorable to qi regulating: eating smaller meals earlier in the day with foods that have mild acrid flavors, small amounts of sour flavors, with an emphasis on large portions of vegetables, while avoiding processed foods, overeating, excessive hot or cold foods, foods with high oil or saturated fat content. (p. 434).
In conclusion, BXXXT has wide clinical applications with or without combing western medicine to treat digestive diseases. Further research needs to be done to explore deeper mechanism and wider applications.
About the author：
Bernadette Eichas is a Licensed Acupuncturist and Herbalist. She graduated as a member of Phi Kappa Phi with her Masters in Acupuncture at the New England School of Acupuncture Japanese Acupuncture Style and Chinese Herbal Medicine in 2024.
Bing Yang is a licensed acupuncturist and herbalist in Massachusetts. She received her Bachelor’s and Master’s degrees in Acupuncture and Chinese Medicine from Beijing University of Chinese Medicine in the 1990s and her Doctoral degree fromachor alese Medicine in the 1990s and her Doctoral degreated orctoriional. Director of Chinese Herbal Programs of New England School of Acupuncture, MCPHS and also maintains a private practice in Boston.
半夏瀉心湯的多種臨床用途與應用
作者：伯納黛特艾查斯、楊冰
麻薩諸塞州藥學與健康大學新英格蘭針灸學院
《傷寒論》是中醫的基礎，為漢代張仲景所著，介紹了因寒邪侵襲人體一個或多個層次而引起的疾病的變化以及治療準則和相應方劑。其中的半夏瀉心湯（BXXXT）臨床應用廣泛，是調節腸胃的傳統中藥方劑，對胃腸道疾病患者有很好的功效。
在中醫看來，一個病人同時存在實證（通常是痰或濕蘊）和虛證（因痰濕而致中焦功能受損），進而出現胃腸鬱積和「寒熱凝結」的情況，會得益於氣機的恢復和陰陽的平衡。傳統上認為這是由於疏泄不當導致太陽寒邪深入內部，侵入胃部，擾亂脾氣機制，但當今臨床上的患者常常過著忙碌的生活方式，吃飯或“邊走邊吃”，或飲食不當，導致了這種情況。
君藥黃連苦（能瀉下）、寒（能清熱），尤對中焦、胃脘有效。臣藥黃芩與君藥具有相同的特點，可以增強君藥的功效。另外兩味臣藥半夏和乾薑溫補中焦。半夏辛溫散結聚，可治噁心、脹滿。乾薑性溫，味辛，能補炙半夏之功效。佐藥人參、大棗，可以補中焦，緩和君藥臣藥的完工之氣，還可以治療噁心。使藥甘草調和中焦與諸藥。隨著氣機恢復脾氣健運，濕熱得清。
根據 Scheid & Bensky, 2015，BXXXT 的臨床適應症包括「局部鼓脹」或 「痞」 症候群－「以上腹部為中心的集中的、局部的不適、堵塞和膨脹的感覺」或「每當脾胃的升降功能因濕氣或痰濕阻滯中焦陽氣而受到干擾時」的情況。 （第 128 頁）臨床患者經常報告主觀上腹不適或飽脹感，但在醫生觸診評估期間沒有明顯的硬度/凸出/腫脹。在當今的診所中，患者會報告各種被歸類為「功能性消化不良」的症狀，該術語用於涵蓋和包括 Talley 等人 (1999) 所描述的「以上腹部為中心的持續性或復發性疼痛或不適；沒有可能解釋這些症狀的器質性疾病證據，包括上消化道內鏡檢查。
BXXXT在現代對患有胃腸道不適和病理情況的患者俱有臨床用途。Gao等人在2024年發現，使用此配方可以對抗慢性萎縮性胃炎患者的胃部發炎（通常來自幽門螺旋桿菌感染）。在中國，近30%的新診斷胃癌病例中，慢性萎縮性胃炎可能是胃癌的先兆。幽門螺旋桿菌通常也與消化性潰瘍和胃潰瘍有關。BXXXT單獨使用或與其他西藥合併使用，在接受西藥治療的FD（功能性消化不良）患者中取得了更多的臨床成功（Kim 等，2023）。根據 Kang 等人的研究，2018年，BXXXT 的適應症是「促進胃腸蠕動，防止逆流，保護胃黏膜，增強免疫系統，提高機體抵抗缺氧的能力。」BXT主要用於治療消化系統疾病，如逆流性食道炎、急慢性胃炎、消化性潰瘍、消化不良、便秘等。
BXXXT的加減應用可以進一步改善臨床效果。如前所述，BXXXT 與西藥合併治療 FD 更有效。Scheid & Bensky，2015指出，現代湯劑與傳統劑量不同，炙半夏的劑量增加了3克（總計9-12克），而炙甘草和大棗的劑量減少了（12粒至4粒），可以進一步保護中焦並防止腹脹。患者可能會受益於採用 Mclean 等人在2018年所說的有利於調節氣機的飲食：每天早些時候少食多餐，吃一些帶有輕微辛味、少量酸味的食物，重點是大量蔬菜，同時避免加工食品、暴飲暴食、過多的熱或冷食物、高油或飽和脂肪含量的食物。 （第 434 頁）。
綜上所述，BXXXT無論是否結合西藥治療消化系統疾病，均具有廣泛的臨床應用前景, 需要進一步研究以探索更深層次的機制和更廣泛的應用。
作者簡介：
Bernadette Eichas是一名持有執照的針灸師和中藥師。她於2024年以Phi Kappa Phi身份畢業於美國麻塞諸塞州藥科健康大學新英格蘭針灸學院，獲得碩士學位。
楊冰，中醫師，九十年代畢業於北京中醫藥大學，獲中醫學學士，碩士學位，後於美國麻省藥科與健康大學獲博士學位。現為麻省藥科大學新英格蘭中醫學院教授，中醫系主任，並在波士頓行醫。
參考文獻
References
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