A Practical Guide to Clinical Indications, Diagnosis, and Differential Use
By Jubong Kang, KMD
Acts and Diagnosis
Huanglian-Jiedu-Tang has the effect of clearing heat, purging fire, drying dampness, and resolving toxicity for the syndrome of flourishing heat in the triple energizer. So this prescription improves symptoms such as fever, vexation, rash, skin eruption, pruritus, carbuncle, furuncle, nosebleed, hematemesis, metrorrhagia, and hematuria, etc.
Here, the flourishing heat of the triple energizer refers to the overheating phenomenon and fever symptoms that occur during digestion, absorption, excretion, and the qi activity of food within the triple energizer. For example, it’s a fever due to exogenous infection that does not resolve quickly and persists; skin inflammation due to consuming large amounts of fatty food; and hemoptysis due to excessive drinking.
In addition, symptoms such as nosebleed or metrorrhagia, stomach acid, gastritis and abdominal pain, or insomnia and insanity, which were caused by excessive nerve exhaustion, also fall under this category.
In this prescription, Huanglian has the functions of clearing heat, drying dampness, purging fire, and resolving toxicity, thereby relieving symptoms such as fever, uneasiness, eruptions, pruritus, hyperacidity, vomiting, dysentery, carbuncles, nosebleeds, and hematemesis; it also acts as a monarch drug.
Huangqin has the functions of clearing heat, purging fire, drying dampness, and resolving toxicity, similar to Huanglian. While Huanglian has functions of eliminating heart-fire and stomach-heat, Huangqin has more functions of eliminating lung-heat, so it alleviates cough due to lung-heat, nose bleeding, heat-type stranguria, dysentery, and fetal anxiety.
Zhizi has functions of clearing heat, purging fire, cooling blood, and resolving toxicity. So, it recovers the symptoms such as insomnia with uneasiness, neurosis, jaundice, diabetes, sore throat, aphtha, rhinophyma, vomiting of blood, nosebleed, bloody diarrhea, hematuria, gonorrhea and pyogenic ulceration with virulent heat-evil.
Huangbai clears away heat, dries dampness, purges fire, resolves toxicity, so it improves dysentery due to damp-heat, jaundice, leucorrhea, heat-type stranguria, eczema, and pruritus.
To sum up, Huanglian relieves the heat of the middle energizer. Huangqin relieves the heat of the upper energizer, Huangbai relieves the heat of the lower energizer, and Zhize relieves the heat of the triple energizer. So it’s said that Huangqin, Huangbai, and Zhizi act as minister or adjuvant drugs to help the Huanglian monarch drug.
This prescription cannot be used in deficient-pattern patients with a weak pulse, pale tongue, or weak abdomen, but is used in cases of the excess pattern. It is widely used alone or in combination with necessary prescriptions, according to symptoms such as inflammation, congestion, and bleeding, in people with reddish faces, palpitations, weak pulse, and a hard abdomen.
Contents in the Source Text
This prescription has a good effect on high fever, vomiting, moans, and sleeplessness; it removes virulent heat-evil and severe heat symptoms. (“Wai Tai Mi Yao”)
Application
Pruritic dermatosis, acne, atopy, seborrheic dermatitis, nose bleeding in excessive pattern, bloody discharge, bloody urine, vomiting of blood, fever after drinking, carbuncle, abscess, pyogenic ulceration, hypertension and melasma.
Distinction
Sanhuang-Xixin-Tang: In this prescription, there is constipation or a tendency to constipation because of Dahuang, and an epigastric glomus appears because of Huangqin and Huanglian. If a patient has constipation with symptoms such as facial flushing, nose bleeding, vomiting of blood, tinnitus, palpitation, pruritus, excitement and anxiety, then Sanhuang-Xixin-Tang is applicable. Even though these symptoms appear, if there is no constipation and the epigastric glomus is not clear, however, if you feel resistance when pressing the lower part of the heart, Huanglian-Jiedu-Tang is used.
Wenqing-Yin: Both Wenqing-Yin and Huanglian-Jiedu-Tang are effective in treating bleeding disorders and pruritic skin diseases. However, because Wenqing-Yin contains Siwu-Tang, it is indicated for patients with blood deficiency. These patients typically present with spasm or tension on palpation of the left lower abdomen, reflecting the Shaoyao pattern, along with blood-deficiency manifestations associated with Siwu-Tang. Consequently, their symptoms tend to worsen at night rather than during the daytime.
