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.
