New Uses of Minor Bupleurum Decoction Bloating Treatment

New Uses of Minor Bupleurum Decoction
abstracted & translated by

Bob Flaws, Lic. Ac., Dipl. Ac. & C.H., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, Xiao Chai Hu Tang (Minor Bupleurum Decoction), post cholecystectomy rib-side pain, hyperbilirubinemia, sticky, stagnant stools

From "New Uses of Xiao Chai Hu Tang (Minor Bupleurum Decoction)" by Shi Shi-ping, Xin Zhong Yi (New Chinese Medicine), #12, 2003, p. 61

Case 1: Post cholecystectomy rib-side pain

The patient was a 66 year-old female who was initially seen on Oct. 12, 2001. Two years previous, due to multiple gallstones, the woman had had her gallbladder removed. In the last two months, she experienced right rib-side distention and pain which radiated to her right shoulder and upper back. In addition, there was heart vexation, a bitter taste in the mouth, nausea, and fear of cold. Ultrasonography revealed that the patient’s liver, bile duct, pancreas, and spleen were free from any abnormalities. Only the extrahepatic bile duct was slightly distended. The woman was treated with antibiotics and anti-inflammatories but without success. Therefore, she turned to Chinese medicine. At the time of her Chinese medical intake, there was rib-side pain which liked pressure, a pale tongue with thin, white fur, and a bowstring pulse. Therefore, Dr. Shin categorized the patient’s pattern as as shao yang conditions and prescribed Xiao Chai Hu Tang with added flavors: Radix Bupleuri (Chai Hu), 12g, Radix Scutellariae Baicalensis (Huang Qin), Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Pinelliae Ternatae (Ban Xia), Semen Raphani Sativi (Lai Fu Zi), uncooked Rhizoma Zingiberis Officinalis (Sheng Jiang), and Radix Glycyrrhizae Uralensis (Gan Cao), 10g each, Radix Auklandiae Lappae (Mu Xiang), 6g, and Fructus Zizyphi Jujubae (Da Zao), 5pieces. Three packets of these medicinals were prescribed, with one packet being decocted in water and administered per day. On Oct. 16, 2001, the woman returned for her second visit. At that time, her rib-side pain was greatly reduced and her eating and drinking had improved. Dr. Shi prescribed another five packets of the same formula and, after that, all the woman’s symptoms disappeared. On follow-up after one year, there had been no recurrence.

Case 2: Hyperbilirubinemia

The patient was a 28 year-old male who was first seen on Jan. 20, 2002. Ten days previous, for no apparent reason, the patient’s sclera had become yellow and his urine had become dark yellow. Two months before, he had developed a bitter taste in his mouth, stomach bloating, and no thought for food or drink. His stools were loose, he sweat profusely, he was fatigued, and he easily caught cold. At the time of examination, his sclera were still yellow and his tongue was fat with teeth-marks on its edges and thin, white, slimy fur. His pulse was bowstring and fine. Total serum bilirubin (TBil) was 58.6Fmol/L, DBil was 15Fmol/L, y-GT was 98IU/L, and hepatitis A virus, HbsAg, and hepatitis C virus were all negative. Ultrasonography showed no abnormalities in the man’s liver, gallbladder, pancreas, and spleen. Therefore, the Western medical diagnosis was hyperbilirubinemia. The man’s Chinese medical pattern was discriminated as liver depression-spleen vacuity. Therefore, he was prescribed Xiao Chai Hu Tang with added flavors: Radix Bupleuri (Chai Hu), Radix Scutellariae Biacalensis (Huang Qin), Rhizoma Pinelliae Ternatae (Ban Xia), Fructus Schisandrae Chinensis (Wu Wei Zi), uncooked Rhizoma Zingiberis Officinalis (Sheng Jiang), and Radix Glycyrrhizae Uralensis (Gan Cao), 10g each, Radix Codonopsitis Pilosulae (Dang Shen), 30g, Herba Artemisiae Yinchenhao (Yin Chen Hao), Sclerotium Poriae Cocos (Fu Ling), and stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu), 20g each, and Fructus Zizyphi Jujubae (Da Zao), 5 pieces. Five packets of these medicinals were prescribed, one packet per day decocted in water and taken internally.

The second visit occurred on Jan. 26. After taking the previous medicinals, the man’s yellow sclera, stomach bloating, and bitter taste all decreased. However, his urine was still yellow, he was still fatigued, and his appetite was still poor. The man’s tongue was fat with white fur, and his pulse was deep and fine. Therefore, 15 grams each of stir-fried Fructus Germinatus Hordei Vulgaris (Mai Ya) and scorched Fructus Crataegi (Shan Zha) were added to the original prescription and another five packets were dispensed. On Feb. 2, the man’s yellow sclera and yellow urine had markedly decreased and his appetite had increased. So another 10 packets of the same formula were prescribed. On Feb. 15, the patient had his forth visit with Dr. Shi. The jaundice had completely disappeared, his TBil was 17.5Fmol/L, DBil was 5.6Fmol/L, and y-GT was 45IU/L. Clinically, the man was considered cured.

Case 3: Sticky, stagnant stools

The patient was a 32 year-old female who was first seen by Dr. Shi on Mar. 5, 2002. For the last four years, this woman’s stools had been sticky, stagnant, and unsmooth. Four years before, after giving birth, the woman had suffered from emotional dysphoria. It was then that her stools had become sticky, stagnant, and unsmooth. This had endured and never really recuperated. In addition, there was rib-side distention, a bitter taste in the mouth, heart vexation, profuse dreams, menstrual irregularity, and heat in the soles of the feet. The woman had already taken draining, precipitating, moistening the intestines Chinese medicinals as well as Western medicines. Initially, there had been some effect, but long-term, the results were poor. Western medical examination of here intestinal tract found no abnormalities. At her Chinese medical examination, the woman’s facial complexion was yellow and there was lassitude of the spirit. Both her cheeks had brownish macules. Her tongue was red with white, glossy fur, and he pulse was bowstring and fine. Based on these signs and symptoms, Dr. Shi categorized this woman’s pattern as a liver-stomach disharmony with large intestine qi stagnation. Therefore, he prescribed Xiao Chai Hu Tang with added flavors: Radix Bupleuri (Chai Hu), Radix Scutellariae Baicalensis (Huang Qin), and Rhizoma Pinelliae Ternatae (Ban Xia), 10g each, Radix Codonopsitis Pilosulae (Dang Shen) and uncooked Rhizoma Atractylodis Macrocephalae (Bai Zhu), 30g each, Radix Auklandiae Lappae (Mu Xiang), uncooked Rhizoma Zingiberis Officinalis (Sheng Jiang), and Radix Glycyrrhizae Uralensis (Gan Cao), 6g each. Dr. Shi prescribed five packets of these medicinals, one packet per day decocted in water and taken internally. On Mar. 10, the patient came in for her second visit. After taking the above medicinals, her stools became normal and smooth or easy. The rib-side distention and bitter taste in the mouth as well as the heart vexation were markedly decreased. The woman continued taking another 10 packets of the same formula and her defecation became completely normal.

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