JOURNAL OF CHINESE MEDICINE NUMBER 66 JUNE 2001


• Constipation: choose from one or more of Yu Li Ren (Semen Pruni) 12-20g, Da Qing Ye (Folium Daqingye) 15g, Da Huang (Rhizoma Rhei) 9g (add at end).


Dry phase following vesicular phase


Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g Bai Ji Li (Fructus Tribuli Terrestris) 20g Fang Feng (Radix Ledebouriellae Sesloidis) 9g Jin Yin Hua (Flos Lonicerae Japonicae) 12g Lian Qiao (Fructus Forsythiae Suspensae) 12g Zhi Zi (Fructus Gardeniae Jasminoidis) 9g Huang Qin (Radix Scutellariae Baicalensis) 9g Fu Ling (Sclerotium Poriae Cocos) 12g Gan Cao (Radix Glycyrrhizae Uralensis) 4g


Modifications • Much fissuring: increase the dose of Sheng Di Huang and Bai Ji Li, and add Xuan Shen (Radix Scrophulariae Ningpoensis) 15g, Huo Ma Ren (Semen Cannabis Sativae) 12g and Zhi Ke (Fructus Citri seu Ponciri) 9g. • Itching: add Chan Tui (Periostracum Cicadae) 9g and Bai Xian Pi (Cortex Dictamni Dasycarpi Radicis) 12g. • Much soreness: use a suitable external emollient. Soaks should not be used at this stage.


• Once the condition resolves, regulate the Liver.


2. Spleen channel damp-heat, with fire-toxin This pattern is mostly seen in pompholyx of the feet, or in cases where digestive symptoms dominate the picture. Typically the patient is prone to reoccurring bouts of foul- smelling diarrhoea, abdominal pain and bloating, and dis- rupted appetite.


Pulse: slippery (hua) or soggy (ru) pulse. Tongue: greasy yellow coating, pale or red tongue body with teethmarks.


Vesicles emerging


Huang Bai (Cortex Phellodendri) 9g Bei Xie (Rhizoma Dioscoreae 12g Zhi Zi (Fructus Gardeniae Jasminoidis) 9g Huang Lian (Rhizoma Coptidis) 6g


Chi Fu Ling (Sclerotium Poriae Cocos Rubrae) 12g Che Qian Zi (Semen Plantaginis) 12g Bai Xian Pi (Cortex Dictamni Dasycarpi Radicis) 12g Di Fu Zi (Fructus Kochiae Scopariae) 12g Bai Jiang Cao (Herba cum Radice Patriniae) 12g Zi Hua Di Ding (Herba Violae cum Radice) 12g Lian Qiao (Fructus Forsythiae Suspensae) 12g Huo Xiang (Herba Agastaches seu Pogostemi) 12g Hua Shi (Talcum) 12g


Gan Cao (Radix Glycyrrhizae Uralensis) 6g


Modifications • Diarrhoea with foul smell: add Chuan Xin Lian (Herba Andrographitis Paniculatae) 9g and increase Bai Jiang Cao to 15g or add Ge Gen (Radix Puerariae) 30g.


• Poor appetite with much bloating and abdominal discom- fort: Sha Ren (Fructus seu Semen Amomi) 9g (crush and add at end), Chen Pi (Pericarpium Citri Reticulatae) 12g and Pei Lan (Herba Eupatorii Fortunei) 9g. • Many blisters with exudation: Ma Chi Xian (Herba Portulacae Oleraceae) 12-15g, and use external soak. • Erythema: Mu Dan Pi (Cortex Moutan Radicis) 9g, Chi Shao (Radix Paeoniae Rubrae) 9g and Jin Yin Hua (Flos Lonicerae Japonicae) 12g. • Yellow pustules: add Ye Ju Hua (Flos Chrysanthemi Indici) 12g and Pu Gong Ying (Herba Taraxaci Mongolici cum Radice) 12g and use external soak. • Involvement of the feet only: increase the dose of Che Qian Zi, Hua Shi and Huang Bai and add Chuan Niu Xi (Radix Cyathulae) 12g.


Dry phase following vesicular phase


Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g Fang Feng (Radix Ledebouriellae Sesloidis) 9g Niu Bang Zi (Fructus Arctii Lappae) 12g Bai Ji Li (Fructus Tribuli Terrestris) 15g Zhi Zi (Fructus Gardeniae Jasminoidis) 9g Huang Qin (Radix Scutellariae Baicalensis) 9g Lian Qiao (Fructus Forsythiae Suspensae) 12g Shan Yao (Radix Dioscoreae Oppositae) 15g Fu Ling (Sclerotium Poriae Cocos) 12g Cang Zhu (Rhizoma Atractylodis) 9g Huo Xiang (Herba Agastaches seu Pogostemi) 9g Gan Cao (Radix Glycyrrhizae Uralensis) 4g


Modifications • Poor response, with clear signs of qi deficiency: reduce fire-toxin resolving medicines, and use Bai Hua She She Cao (Herba Oldenlandiae Diffusae) 30g, Shan Yao (Radix Dioscoreae Oppositae) 15g and Huang Qi (Radix Astragali) 20g as the basis of the formula.


• Once the condition resolves, support the Spleen.


3. Qi and blood deficiency with fire-toxin and hot blood This pattern is seen in chronic cases with few or no vesicles and milder itching. The picture is dominated by fissures and dry and sore skin. Erythema is often present. This prescription may need to be alternated with more actively removing fire-toxin as in previous prescriptions, for example in cases of mixed patterns where vesicles become more pronounced in an otherwise dry pattern. Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g Mu Dan Pi (Cortex Moutan Radicis) 9g Bai Ji Li (Fructus Tribuli Terrestris) 20 g Chan Tui (Periostracum Cicadae) 9 g Jin Yin Hua (Flos Lonicerae Japonicae) 12 g Ye Ju Hua (Flos Chrysanthemi Indici) 12 g Dang Gui (Radix Angelicae Sinensis) 9 g Bai Shao (Radix Paeoniae Lactiflorae) 15 g He Shou Wu (Radix Polygoni Multiflori) 12 g Huang Qi (Radix Astragali) 15g


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