41 Journal of Chinese Medicine | Issue125 | February 2021 Professor Huang Huang’s Clinical Application of Da Chai Hu Tang He Gui Zhi Fu Ling Wan The original lines and formula ingredients of Da Chai Hu Tang Da Chai Hu Tang was first mentioned in the Shang Han Za Bing Lun; the formula is mentioned in three different lines in the Shang Han Lun and once in the Jin Gui Yao Lüe. Shang Han Lun, line 103: When in greater yang disease, ten or more days aﬅer channel passage, precipitation [has] instead [being used] two or three times, aﬅer four or ﬁve days, [if ] the [Minor] Bupleurum [Decoction] ([xiǎo] chái hú [tāng]) pattern is still present, first give Minor Bupleurum [Decoction] ( xiǎo chái hú [tāng]). If [there is] incessant retching, distress below the heart, and depression and mild vexation, it means [that the disease] has not yet resolved; giving Major Bupleurum Decoction (dà chái hú tāng) to precipitate will lead to recovery. 5 《伤寒论》第 103 条：太阳病，过经十余日，反二三下之，后四五日，柴胡证仍在者，先与小柴胡。呕不止，心下急，郁郁微烦者，为未解也，与大柴胡汤，下之则愈。 6 Shang Han Lun, line 136: When cold damage [has lasted for] more than ten days, [and] heat binds in the interior, yet [there is] alternating [aversion to] cold and heat [eﬀusion], give Major Bupleurum Decoction (dà chái hú tāng); if [there is] only chest bind and great heat [effusion] is absent, indicating water bind in the chest and rib-side, and slight sweat issuing only from the head, Major Chest Bind Decoction (dà xiàn xiōng tāng) governs. 《伤寒论》第136条：伤寒十余日，热结在里，复往来寒热者，与大柴胡汤；但结胸，无大热者，此为水结在胸胁也，但头微汗出者，大陷胸汤主之。 7 Shang Han Lun, line 165: When in cold damage [there is] heat eﬀusion and sweating [that brings] no resolution, hard glomus in [below] the heart, retching, vomiting, and diarrhea, [then] Major Bupleurum Decoction (dà chái hú tāng) governs. 《伤寒论》第165条：伤寒，发热，汗出不解，心中痞硬，呕吐而下痢者，大柴胡汤主之。 8 Jin Gui Yao Lüe, Abdominal Fullness, Cold Mounting, and Abiding Food, Pulses, Signs and Treatments, line 10.12: When on pressing there is fullness and pain below the heart, this is repletion. One should precipitate this. Major Bupleurum Decoction (dà chái hú tāng) is appropriate. 《金匮要略· 腹满寒疝宿食病脉证治第十》：按之心下满痛者，此为实也，当下之，宜大柴胡汤。 9 The ingredients and dosages of Da Chai Hu Tang are consistent in both Shang Han Lun and Jin Gui Yao Lüe. The latter text formulates them as follows: Chai Hu (Bupleuri Radix) ½ jin Huang Qin (Scutellariae Radix) 3 liang Shao Yao (Paeoniae Radix) 3 liang Ban Xia (Pinelliae Rhizoma preparatum) ½ sheng (washed) Zhi Shi (Aurantii Fructus immaturus) 4 pieces Da Huang (Rhei Radix et Rhizoma) 2 liang Da Zao ( Jujubae Fructus) 12 pieces (broken) Sheng Jiang (Zingiberis Rhizoma recens) 5 liang (sliced) Boil the above eight ingredients in one dǒu and two shēng of water to get six shēng. Remove the dregs and decoct again. Take one shēng [per dose] warm, three times a day. 右八味，以水一斗二升，煮取六升，去滓，再煎，温服一升，日三服。 e Shang Han Lun version only also contains the following sentence, highlighting the importance of Da Huang: If Dà Huáng is not added, this is not Major Bupleurum Decoction (dà chái hú tāng). 若不加大黄，恐不为大柴胡汤也。 The importance of Da Huang In China, it is common practice to subtract Da Huang when prescribing Da Chai Hu Tang as many doctors believe its coldness would cause patients to have diarrhoea, even if the original lines in the Shang Han Lun and Jin Gui Yao Lüe stress the importance of this ingredient in the formula. Medical books from the Tang Dynasty, such as the Wai Tai Mi Yao (外台秘要, Arcane Essentials from the Imperial Library), 10 and the Ming Dynasty (明朝), such as Zu Ji (祖剂, Ancestral Formulas) 11 include the same words as the Shang Han Lun, underscoring the importance of Da Huang in this formula: Da Huang two liang. If it is not added, this is not Major Bupleurum Decoction (Da Chai Hu Tang). 大黄二两，若不加恐不为大柴胡汤。 Based on Professor Huang’s cases where Da Chai Hu Tang was prescribed successfully, it was observed that the formula’s patient population displayed or reported the following physical characteristic and clinical traits: robust body build, medium weight to overweight, oily face,