Chai Hu Gui Zhi Gan Jiang Tang: A TCM Remedy for Shaoyang Disorders and Fluid Retention

Hongji Medical
Jun 1
4 min read

Bupleurum, Cinnamon Twig, and Dried Ginger Decoction, known as Chai Hu Gui Zhi Gan Jiang Tang, is a classic formula from the Eastern Han Dynasty physician Zhang Zhongjing’s Treatise on Cold Damage and Miscellaneous Diseases. This time-honored remedy is primarily used to treat Shaoyang disorders caused by external wind-cold invasions, accompanied by internal fluid retention.

Historical Context of Chai Hu Gui Zhi Gan Jiang Tang

The Treatise on Cold Damage and Miscellaneous Diseases describes this formula for patients with symptoms persisting after five or six days of illness, even after sweating or purgative treatments.

The text notes: “For a cold-induced illness lasting five or six days, after sweating and purging, if there is chest and rib fullness, difficulty urinating, thirst without vomiting, sweating only on the head, alternating chills and fever, and irritability, the condition remains unresolved. Chai Hu Gui Zhi Gan Jiang Tang is indicated.”

This highlights its role in addressing symptoms like chest fullness, urinary issues, thirst, head sweating, alternating chills and fever, and irritability caused by wind-cold.

Formula Composition and Roles

The decoction is composed of carefully selected herbs, organized according to the TCM principle of “monarch, minister, assistant, and envoy”:

Monarch: Bupleurum (Chai Hu)Bupleurum is the primary herb, relieving exterior symptoms, dispersing heat, and harmonizing the liver and spleen. It addresses Shaoyang imbalances, promoting smooth liver qi flow and spleen function.
Ministers: Cinnamon Twig (Gui Zhi) and Dried Ginger (Gan Jiang)Cinnamon Twig disperses cold, harmonizes ying (nutritive) and wei (defensive) qi, while Dried Ginger warms the middle, dispels cold, and resolves fluid retention. Together, they regulate qi and warm the spleen and stomach to clear internal cold and fluid buildup.
Assistants and Envoy: Trichosanthes Root (Gua Lou Gen), Oyster Shell (Mu Li), and Honey-Fried Licorice (Zhi Gan Cao)Trichosanthes Root and Oyster Shell resolve fluid retention in the chest and abdomen, while Honey-Fried Licorice harmonizes the formula, enhancing its overall efficacy.

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Pathophysiology

The formula targets two main pathological conditions:

Shaoyang Disorder: This involves dysfunction of the gallbladder and liver, which are central to the body’s qi regulation. External wind-cold or emotional stress can disrupt Shaoyang qi flow, causing internal heat, liver qi stagnation, and symptoms like alternating chills and fever. Bupleurum and Scutellaria (if included in variations) harmonize Shaoyang qi and relieve these symptoms.
Internal Fluid Retention: When the body’s water metabolism is impaired, fluid accumulates in the chest, ribs, or digestive system, leading to chest fullness, difficulty urinating, and thirst without vomiting. Trichosanthes Root and Oyster Shell clear fluid buildup, while Cinnamon Twig, Dried Ginger, and Licorice warm the spleen and stomach to resolve cold-related fluid retention.

By addressing both Shaoyang imbalance and fluid retention, the formula restores balance and improves overall health.

Indications and Benefits

The decoction is primarily indicated for Shaoyang disorders with fluid retention, presenting symptoms such as:

Chest and rib fullness
Difficulty urinating
Thirst without vomiting
Sweating only on the head
Alternating chills and fever
Irritability

These symptoms are typically triggered by wind-cold invasions affecting the Shaoyang channel.

The formula is a variation of Xiao Chai Hu Tang (Minor Bupleurum Decoction), which treats Shaoyang disorders by relieving exterior symptoms and harmonizing the liver and spleen. Chai Hu Gui Zhi Gan Jiang Tang adds Cinnamon Twig, Dried Ginger, Trichosanthes Root, and Oyster Shell, replacing Ginseng, Pinellia, Ginger, and Jujube, to enhance its ability to warm the interior and resolve fluid retention.

Mechanism of Action

The formula’s herbs work synergistically to:

Harmonize Shaoyang qi with Bupleurum to relieve alternating chills and fever.
Clear fluid retention with Trichosanthes Root and Oyster Shell.
Warm the spleen and stomach with Cinnamon Twig, Dried Ginger, and Licorice to resolve cold-related fluid buildup.
Harmonize the formula with Licorice to enhance efficacy.

This combination effectively treats chest fullness, urinary issues, thirst, head sweating, alternating chills and fever, and irritability.

Modern Applications

In modern TCM, Chai Hu Gui Zhi Gan Jiang Tang is widely used for conditions involving Shaoyang disorders and fluid retention. It is particularly effective for digestive disorders, including:

Gastric and duodenal ulcers
Gastric prolapse
Chronic gastritis
Chronic colitis
Acute and chronic cholecystitis
Gallstones
Biliary infections
Acute and chronic hepatitis
Liver cirrhosis
Acute peritonitis
Irritable bowel syndrome
Chronic diarrhea

Beyond digestive issues, the formula is applied to:

Respiratory Conditions: COVID-19, tuberculosis, lymphadenitis, pleurisy, acute and chronic bronchitis, and post-pleurisy complications.
Urological Conditions: Acute and chronic nephritis, nephrotic syndrome, and uremia.
Neurological and Psychiatric Conditions: Neurasthenia, hysteria, neurosis, schizophrenia, palpitations, insomnia, depression, and anxiety.
Gynecological Conditions: Adnexitis, dysfunctional uterine bleeding, and breast hyperplasia.

Precautions for Use

When using Chai Hu Gui Zhi Gan Jiang Tang, consider the following:

Pattern Differentiation: The formula is specific to Shaoyang disorders with fluid retention, characterized by chest fullness, difficulty urinating, thirst without vomiting, head sweating, alternating chills and fever, and irritability. Proper diagnosis by a TCM practitioner is essential to ensure suitability.
Individual Variations: Adjust the formula based on the patient’s constitution, under professional guidance.
Contraindications: Avoid in patients with weak constitutions, excessive sweating, or weak pulses, as it may worsen their condition.

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Conclusion

Chai Hu Gui Zhi Gan Jiang Tang is a time-honored TCM formula with a unique blend of herbs that harmonize Shaoyang qi and resolve fluid retention. Its ability to address symptoms like chest fullness, urinary issues, thirst, head sweating, alternating chills and fever, and irritability makes it a valuable remedy. With applications in digestive, respiratory, urological, neurological, and gynecological conditions, it remains relevant in modern medicine. Always consult a qualified TCM practitioner to ensure safe and effective use, tailored to individual needs. This formula’s historical significance and broad therapeutic potential continue to enhance patient well-being.

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中醫知識

Chinese Medicine - Qi

Blood and semen

Heart and lungs

Spleen and Liver

Kidney

Gallbladder, stomach, intestines, bladder

Interrelationships among the five internal organs

Other questions

Qi is the constantly moving subtle substance that constitutes the human body and maintains its vital activities.

There are three main sources of Qi in the human body: the innate essence inherited from parents, the essence of water and grain in food, and the pure Qi existing in nature.

Qi has many important physiological effects on the human body. The normal functioning of the internal organs, meridians, limbs, bones, five senses and nine orifices all depends on the physiological effects of Qi.

Generally speaking, the physiological effects of Qi include five aspects: promotion, warming, defense, consolidation, and qi transformation.

Yuan Qi is the most original Qi in the human body.

Yuan Qi is mainly composed of the essence of the kidneys and is generated from the essence of the kidneys.

The distribution of primordial energy is throughout the body, reaching everywhere. The internal organs, meridians, body parts, five senses and nine orifices are all places where primordial energy rises, falls, enters and exits.

The main physiological functions of Yuan Qi are twofold: one is to promote and stimulate the growth, development and reproduction of the human body. The other is to promote and stimulate the physiological activities of the internal organs and meridians.

If the kidneys are deficient in essence and energy due to congenital deficiency, postnatal malnutrition, or long-term illness, and the kidneys lack the source of vital energy, various diseases may occur.

Zong Qi is the Qi that accumulates in the chest. The place where Zong Qi accumulates is called "Tan Zhong" (between the two breasts). Because it is the place where Zong Qi is most concentrated, it is also called "Qi Hai".

Zong Qi is mainly composed of the fresh air from nature inhaled by the lungs and the essence of water and grain produced by the spleen and stomach from food.

The main functions of Zong Qi are twofold:

1. It is to walk the Xi Dao to control breathing. All breathing, speech, and voice are related to the Zong Qi. When the Zong Qi is abundant, the breathing is slow and the rhythm is even, the speech is clear and the voice is loud; otherwise, the breathing is short and the voice is low.

Second, it is to circulate Qi and blood through the heart meridians. All the beating of the heart and the circulation of Qi and blood are related to Zong Qi. If the pulse is gentle, the rhythm is consistent, and there is spirit and root, it is a manifestation of abundant Zong Qi. On the contrary, if the pulse is agitated, scattered, weak, or irregular, it means that the Zong Qi is insufficient or even weak.

Zhongqi refers to the Qi of the middle burner. Because the spleen and stomach are located in the middle burner, the Qi of the spleen and stomach is generally called "Zhongqi".

It is generally believed that the formation of Zhong Qi is formed by the combination of the Yuan Qi distributed in the Zhongjiao and the water and grain essence produced by the spleen and stomach.

The middle qi is mainly distributed in the middle burner, spreading between the spleen, stomach, and intestines, and it rises and falls, constantly mediating.

The main functions of Zhongqi include three aspects:

1. It controls the rise and fall of Qi. The middle burner is the hub of the rise and fall of Qi. When the middle Qi is abundant and harmonious, the Qi of the liver and spleen will rise healthily, and the Qi of the lungs and stomach will descend smoothly. When the rise and fall are smooth, all organs will be at peace.

Second, it stimulates the spleen and stomach to absorb and transport. When the middle qi is abundant, the spleen rises and the stomach descends normally, the water and grain are received and transported normally, and the essence of water and grain is continuously produced to generate qi and blood, nourishing the whole body.

Third, it maintains the position of the internal organs. The reason why the internal organs maintain their relatively constant position depends on the rise and fall of the qi of the middle jiao spleen and stomach.

Ying Qi, also known as "Rong Qi", is the Qi that flows in the veins.

The distribution and movement of Ying Qi are clearly discussed in Suwen Bi Lun, which points out that Ying Qi "harmonizes the five internal organs, flows through the six bowels, and then enters the meridians."

It explains that the nutrient energy enters the meridians, circulates throughout the body, flows into the internal organs, and reaches the limbs, repeating the cycle over and over again.

The main functions of Ying Qi:

1. It is the transformation of blood.

Second, it nourishes the whole body. The nourishing qi enters the blood vessels and causes the body fluids to penetrate into the blood vessels. The two combine to form blood.

The so-called Qi can produce blood, mainly refers to: Ying Qi transforms into blood. Ying Qi is produced by the refined part of the essence of grains, and is a nutrient necessary for physiological activities such as viscera and meridians, and plays an important role in maintaining human life activities.

The Inner Canon of Medicine states that the Nutritive Qi "harmonises the five internal organs, and spreads throughout the six bowels", "nourishes the four extremities", etc., which emphasizes that the Nutritive Qi has a nourishing effect.

Wei Qi is the Qi that circulates outside the veins. It is so called because it protects the skin and resists external pathogens.

The distribution of Wei Qi is fast, smooth and agile, and is not restricted by blood vessels, so it can "flow through the skin, between the flesh, fumigate the peritoneum, and spread to the chest and abdomen" (Suwen Bi Lun). This shows that Wei Qi spreads throughout the body, externally between the skin and muscles, and internally to the peritoneum of the chest and abdomen - the area inside the diaphragm of the chest cavity.

The main physiological functions of Wei Qi are three-fold:

First, it protects the skin and prevents the invasion of external pathogens. In clinical practice, if a patient is prone to colds and fever, the treatment is usually based on the theory that the Wei surface is not solid. The theoretical basis is here. Second, it warms the internal organs, muscles, fur, etc. Wei Qi has a strong warming effect. If Wei Yang is deficient, the warming power is weakened, and cold symptoms such as cold body, cold limbs and low body temperature may appear. If Wei Qi is stagnant and turns into heat, hot symptoms such as fever and malignant fever may appear.

Third, it regulates the opening and closing of pores and controls sweat excretion, which is what Lingshu Benzang says about the Wei Qi having the function of “controlling opening and closing”.

Chai Hu Gui Zhi Gan Jiang Tang: A TCM Remedy for Shaoyang Disorders and Fluid Retention

Historical Context of Chai Hu Gui Zhi Gan Jiang Tang

Formula Composition and Roles

Pathophysiology

Indications and Benefits

Mechanism of Action

Modern Applications

Precautions for Use

Conclusion

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中醫知識

The concept of Qi

Vitality

Zong Qi

Middle Qi

Ying Qi

Health

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