After collecting, organizing and analyzing research papers on Major Bupleurum Combination (Da Chai Hu Tang), I have discovered that this formula is most commonly used for infectious diseases of the liver, gallbladder and pancreas, and choleocystitis in particular. Following is the case study of a 36-year-old woman from September 21st, 2002.
Three years previously the patient had frequent attacks of upper abdominal pain, which after undergoing an ultrasound was determined to be the result of choleocystitis, hepatitis, and a hepatic cyst. During that time, she took both Western medicines and Chinese patent medicines, but they provided only periodic relief. She had come in at this time because she had been experiencing pain for a month. The patient was of moderate build with a slightly dusky complexion and coarse skin. She complained of upper abdominal pain, lack of appetite, bitterness in the mouth, vexation during sleep, abdominal bloating, sloppy stools 2-3 times per day, and lassitude. Her tongue was red with a yellow coating, and her pulse was wiry.
Abdominal diagnosis revealed a flat abdomen, with pain in its upper aspect upon palpation. There was resistance in the abdomen when pressed and her lower abdominal muscles were tense. She also had discomfort when pressure was applied to the area below her ribs.
Prescription: Bupleurum (Chai Hu) 12g, Scute (Huang Qin) 10g, Processed Pinellia Rhizome (Zhi Ban Xia) 10g, White Peony (Bai Shao) 10g, Processed Rhubarb (Zhi Da Huang) 5g, Fresh Ginger (Sheng Jiang) 3 slices, Jujube (Hong Zao) 6 pieces.
The patient returned after seven days and said that she felt noticeably better after taking the herbs. Her energy had improved; her bowel movements were formed and had decreased to once per day. After 14 more doses of the same formula all of her symptoms had resolved.
Major Bupleurum Combination (Da Chai Hu Tang): A Natural Formula for Regulating Fat Metabolism
Although abdominal bloating and pain are not symptoms generally related to high cholesterol or being overweight, people with these symptoms are often of a solid, heavy build, said to be of a solid fat body type. The abdomens of these people are often firm and feel strong to the touch when pressure is applied. If such patients are suffering from mental/emotional conditions such as insomnia and vexation as well as constipation then this formula is applicable. Recent medical research has found that Bupleurum (Chai Hu), Scute (Huang Qin), and Rhubarb (Da Huang) all have the ability to lower blood cholesterol. The ability of Rhubarb (Da Huang) to lower cholesterol may be its ability to prevent fat absorption in the intestines. When using this formula to treat high cholesterol or obesity, Alisma (Ze Xie) and Hawthorn Fruit (Shan Zha) should be added. However, in order for the formula to be effective, it needs to be taken for a long period of time, usually around 2 months, and controlling food intake is of course essential. When taking this formula to lower cholesterol or lose weight, it is very important to assess the patient's body type. Those suitable for use of Major Bupleurum Combination (Da Chai Hu Tang) usually have short necks, wide shoulders, a large chest measurement that is equal to the measurement of their lower ribs and an abdomen that is firm and strong to pressure. Major Bupleurum Combination (Da Chai Hu Tang) has a muscle relaxing effect, so is suited for those with a tense body type. It is not suited for those with so-called “depletion fat”, those with soft flabby body types.
Because it contains Rhubarb (Da Huang), the question arises: must a patient have constipation to use Major Bupleurum Combination (Da Chai Hu Tang)? Not necessarily. Zhang Zhong Jing mentions “xia li”, diarrhea, in relation to this formula and not constipation. This formula can also treat bacterial dysentery, so the function of Rhubarb (Da Huang) is to drain heat not merely to free the stools. When Zhang Zhong Jing uses Rhubarb (Da Huang) for the purpose of purging and freeing the stools, most often he recommends using it in large quantities, untreated, or added at the end of decocting. However, when using Major Bupleurum Combination (Da Chai Hu Tang), it is not necessary to use Rhubarb (Da Huang) in large doses, or add at the end of decocting. It is not to be used in doses for purging. If a patient has constipation slightly larger than normal, doses of unprepared Rhubarb (Da Huang) can be used, but if there are no signs of constipation, then small doses of treated Rhubarb (Zhi Da Huang) should be used.
There are many other uses of Major Bupleurum Combination (Da Chai Hu Tang), for example, heart-vexation, insomnia, impotence, diabetes, gout, and high blood pressure. As long as the patient has a strong, solid body type and pressure on the region below the heart feels full and induces pain, this formula can be used.
Other Bupleurum Formulas (Other Chai Hu Formulas)
Another one of the Bupleurum formulas from Shang Han Lun is Bupleurum, Cinnamon Twig, and Ginger Decoction (Chai Hu Gui Zhi Gan Jiang Tang). A harmonizing formula that is beneficial for those people with weak glandular constitutions. Bupleurum, Cinnamon Twig, and Ginger Decoction (Chai Hu Gui Zhi Gan Jiang Tang) contains Bupleurum (Chai Hu), Trichosanthes Root (Gua Lou Gen), Scute (Huang Qin), Oyster Shell (Mu Li), Dried Ginger (Gan Jiang), Licorice (Gan Cao), and Cinnamon Twigs (Gui Zhi).
Clinically it can be used to treat menopausal problems, vascular problems, insomnia, psychological disorders, athletes foot, tuberculosis, and pleurisy. Signs and symptoms that this formula treats include nervousness, chest fullness and discomfort, abdominal pulsations, palpitations and excitability, perspiration on the head or night sweats, remittent fever (external patterns), as well as insomnia, mild thirst (no signs of nausea), soft stools, anemia, slight feverishness, chest and abdominal repletion, exterior depletion heat with internal cold, insufficient body fluids or signs of lacking of water, reduced urination, tense abdominal muscles with and a feeling of Qi surging upward from the abdomen. Another formula, Bupleurum & Mu Li Combination (Chai Hu Jia Long Gu Mu Li Tang) is used to treat a restless spirit, insomnia, and palpitations.
The Bupleurum (Chai Hu) family of formulas is a versatile group of formulas with a wide range of application, including digestive, nervous and immune disorders, respiratory ailments and gynecological disorders. Minor Bupleurum Combination (Xiao Chai Hu Tang) also has an immune boosting effect that has the potential to be very useful in treating contagious diseases. Having been originally designed to treat Shao Yang/Yang Ming disorders makes Major Bupleurum Combination (Da Chai Hu Tang) ideally suited to treat digestive disorders, particularly those that involve problems with peristalsis, as well as various conditions of the liver and gallbladder.
The author of this article is a retired TCM practitioner. He is now doing research on ancient documents of traditional Chinese medicine.