Ma Huang Tang (Ephedra Decoction)
- Release Exterior Wind Cold
- Ma Huang (Ephedra Herba) ................ 9g
- Gui Zhi (Cinnamomi Ramulus) ............ 6g
- Xing Ren (Armeniacae Semen) ........... 70 pcs (9-12g)
- Zhi Gan Cao (Glycerrhizae Radix Preparata) .. 3g
Method of Preparation: Decoct Ma Huang (Ephedra Herba) in approximately 9 cups of water until 7 cups remain. The froth is removed, the other ingredients are added, and the resultis decocted until approximately 2.5 cups remain. The strained decoction is taken warm in 3 doses. At present, all of the ingredients are decocted together, and it is thought that they should be cooked for no longer than 20 minutes. The decoction is taken hot to induce significant sweating. Once sweating occurs, the formula should not be taken again.
Actions: Releases exterior cold and arrests wheezing.
Indications: Fever and chills (chills predominant) without sweating, headache, generalized body aches, wheezing, a thin, white tongue coating, and a floating, tight pulse.
This is wind-cold attacking the exterior where it fetters, constrains, or 'bottles up' the protective qi. This inhibits the flow of the yang qi in the exterior, which produces chills. The struggle between the external pathogenic influence and the normal qi causes fever and makes the skin warm to the touch. The head is the meeting place of the yang channels, and an attack of wind cold on the superficial (yang) aspects of the body gives rise to headache. Cold causes the interstices and pores to close and prevents sweating. It also interferes with the flow of nutritive qi and the muscle layer and channels, which produces generalized body aches. The bottling-up of the exterior constrains the normal dissemination of Lung qi. This results in rebellious Lung qi that manifests as a harsh, barking cough or wheezing. Since this is an exterior condition only, the tongue is not affected. The floating pulse indicates that the pathogenic influence is in the exterior, and the tight pulse indicates the presence of cold.
Analysis of Formula: The pattern treated by this formula is caused by severe wind-cold fettering the protective yang in the exterior, which constrains the dissemination of Lu qi. This requires the use of a strategy that focuses on resolving the exterior with acrid and strongly warming herbs, while secondarily supporting the dissemination and downward-directing of Lung qi.
The chief herb, warm, acrid Ma Huang (Ephedra Herba), is a particularly strong diaphoretic that also disseminates the Lung qi and treats wheezing. The deputy, Gui Zhi (Cinnamomi Ramulus), is also a diaphoretic that releases the exterior (especially the muscle layer) and warms and facilitates the flow in the channels. When combined with the chief herb, it strengthens the diaphoretic effect of the formula. This combination is very effective at releasing the exterior. The assistant Xing Ren (Armeniacae Semen), is bitter and slightly warm. It directs Lung qi downward to help the chief ingredient arrest wheezing and expel the pathogenic influence. Its oily nature simultaneously moderates the acrid quality of the two main diaphoretic herbs to protect the Lung, which is averse to dryness. The envoy Zhi Gan Cao (Glycerrhizae Radix Preparata), harmonizes the actions of the other herbs, moderates the diaphoretic action of Ma Huang (ephedra Herba), and protects against the slight toxicity of Xing Ren (Armeniacae Semen).
Commentary: This is the classic formula for treating cold excess in the exterior. Its primary focus is to stimulate sweating. It appears at least nine times in Discussion of Cold Damage for treatment of Tai Yang disorders where the presentation is referred to as cold damage. It was argued that Ma Huang (Ephedra Herba) combines all the actions needed to address the various aspects of cold damage pathology. Besides inducing sweating and opening up Lung constraint, Ma Huang also enters the Bladder and functions as a diuretic. This allows it to push out cold that has already penetrated deeper into Tai Yang. The interaction of chief and deputy herbs such as Ma Huang and Gui Zhi has in the past been a focus of the formula. Ma Huang relieves the constraint of protective qi in the exterior to open the pores and interstices, while Gui Zhi penetrates deeper into the muscle layer and channels to open up areas of stagnation of the nutritive qi, so that pathogens can also be vented out from there.
The deputy not only enhances the diaphoretic effect of the chief herb, but also checks and controls it. This is a purely yang formula, which only discharges and disperses. Key signs and symptoms define the classical cold damage pattern (absence of sweating, chills, and high fever). If sweating does not resolve the fever, or if the fever actually increases, this indicates the presence of a wind-cold pathogen. Similarly, a predominance of chills need not be present in every single case for which Ma Huang Tang may be indicated. One can make the diagnosis of cold damage if the chills are particularly pronounced at the onset of the disorder or if they persist for a relatively long period of time even as the fever rises. While many textbooks present fever accompanied by thirst and a rapid pulse to be a distinguishing feature of warm pathogen disorders, they can also occur with wind-cold invasion. In these cases, however, a sensation of dryness in the mouth will not be accompanied by much thirst, or the thirst will be for warm rather than cold drinks. The pulse, although rapid when measured against a normal resting pulse, will be less fast than one would expect given the oftentimes high fever.
Besides wind-cold fevers without sweating, the most common contemporary applications of this formula are for cough and wheezing due to cold, and painful obstruction due to wind-cold-dampness. It is also used for nosebleeds with an absence of sweating and a floating, tight pulse. This is a specific type of nosebleed due to cold. In this case, wind-cold 'bottles up' the exterior and constrains the yang, which surges upward and causes the nosebleed. Less well known is its use in gynecology. Both the Chinese and the Japanese case history literature documents the successful treatment of painful periods and difficult labor with Ma Huang Tang. This can be explained by the formulas ability to unblock obstruction due to cold, and by the fact in classical texts, the word Bladder (Pang Guang) is a term that can refer to the pelvic organs in general, and not just the bladder. Ma Huang Tang has been recommended with the addition of Fu Ling (Poria Cocos), Mu Dan Pi (Moutan Cortex), Tao Ren (Persicae Semen), Ai Ye (Artemesiae Argyi Folium), Shao Yao (Peoniae Radix), Chuan Xiong (Chuanxiong Rhizoma) for the treatment of dysmenorrhea, abdominal masses, pelvic inflammatory disease, and similar disorders, provided that the overall symptom pattern matches the formulas presentation.
Ma Huang Tang is the foundation for a number of other formulas that are used in treating disorders associated with wind affecting the Lungs, including Xiao Qing Long Tang (Minor Bluegreen Dragon Decoction) and Ma Xing Shi Gan Tang (Ephedra, Apricot Kernal, Gypsum, and Licorice Decoction).
Biomedical Indications: With appropriate presentation, this formula may be used to treat a wide variety of biomedical-defined disorders. These can be divided into the following groups:
- Acute externally-contracted diseases such as the common cold, influenza, rheumatic fever, pneumonia, rhinitis, pharyngitis, otitis media, and the early stages of mastitis.
- Disorders marked by pain such as traumatic arthropathy, cervical spine disease, lumbar strain, periarthritis of the shoulder, rheumatoid arthritis, ankylosing spondylitis, Raynaud's disease, sciatica, trigeminal neuralgia, migraine, sinusitis, and scleroderma.
- Disorders marked by wheezing such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, hay fever, and pericardial effusions.
- Dermatological diseases marked by dry skin such as some forms of eczema, urticaria, and chilblains.
- Other disorders such as glomerulonephritis, pylenonephritis, benign prostatic hypertrophy, ascites, phlebitis, and solar dermatitis.
Cautions and Contraindications: In Discussion of Cold Damage, this formula is contraindicated for patients with debility and copious urination, and for patients who are prone to bleeding (especially from the nose). Because of the adrenergic effects of MA Huang (Ephedra Herba), this formula should be used with caution in cases with hypertension. In addition, it is designed only to be used for very short periods of time.
- For exterior cold with interior heat, ad Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), or Huang Qin (Scutellariae Radix).
- For concurrent qi and blood deficiency, add Huang Qi (Astragalus Radix), Ren Shen (Ginseng Radix), Dang Gui (Angelicae Sinensis Radix), and Shu Di Huang (Rhemanniae Radix Preparata).
- For sore throat, reduce the dosage of Gui Zhi (Cinnamomi Ramulus) by half, and add Tian Hua Fen (Trichosanthis Radix), and She Gan (Belamcandae Rhizoma).
- For external wind-cold invasion accompanied by dampness, combine Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopteryhii Rhizoma Seu Radix), and Bai Zhu (Atractylodis Macrocephelae Rhizoma).
- To Disseminate and direct Lung Qi downward in cases with wheezing, cough, and phlegm, add Su Zi (Fructescentis), Sang Bai pi (Mori Cortex), Fu Ling (Poria Cocos), and Chen Pi (Citri reticulate Pericarpium).
- Where trauma is accompanied by contraction of wind-cold, add Tao Ren (Persicae Semen), Hong Hua (Carthami Flos) to invigorate blood and open the collaterals.