bubble_chart Indications

Intense internal heat causing heart pain and epigastric pain.

bubble_chart Formula Principles

Middle-Clearing Decoction is a commonly used formula in clinical treatment for epigastric pain caused by dampness-heat obstruction in the middle energizer. This formula is derived from Two Old Ingredients Decoction with the addition of Gardenia, Coptis Rhizome, and Alpinia Seed. In the formula, Two Old Ingredients Decoction is used as the monarch to clear dampness-heat in the middle energizer. Gardenia, with its bitter and cold properties, clears heat and treats stomach heat. Coptis Rhizome, also bitter and cold, enters the middle energizer to clear heat and dry dampness. When combined, these two enhance the ability to clear stomach heat, serving as minister medicinals. When there is heat in the middle energizer, using Gardenia and Coptis Rhizome to clear heat with bitter and cold properties may lead to rejection, so Alpinia Seed is added. Its acrid and warm nature dries dampness, strengthens the spleen, and warms the stomach, acting as a corrigent, making it easier for pathogens to be subdued and the disease to be cured. Liquorice Root harmonizes the other medicinals as the envoy. When all the medicinals are used together, dampness-heat is eliminated, and stomach qi is harmonized. In the Ming dynasty, Fang Gu, in his book "Yilin Mosheng," based on Zhang Zi-he's theory that "all medicinals are born from qi, and all diseases arise from qi," proposed that at the onset of qi disorders, Two Old Ingredients Decoction should be the main formula, with a minimal use of bitter and cold medicinals within the acrid and warm framework. For treating stomach fire, Two Old Ingredients Decoction is combined with Coptis Rhizome and hawthorn fruit, which aligns closely with the formulation principles of this formula.

1. For dampness predominance, add Coix Seed, Hyacinth Bean, Patchouli, Fortune Eupatorium;
2. for heat predominance, add Skullcap Root, Dandelion, Sophora;
3. for constipation, add Immature Orange Fruit, processed Rhubarb Rhizoma;
4. for nausea and vomiting, add Bamboo Shavings to clear heat and harmonize the stomach, and to lower the adverse flow of qi.

bubble_chart Documentation

Li, male, 28 years old, first visited on April 8, 1984. He complained of burning pain in the stomach area for two months, which had not improved. The pain radiated to the shoulders and back, worsened in the evening, and was accompanied by a decrease in appetite, bitter taste in the mouth, acid reflux, occasional belching, yellow and painful urination, a thin yellow tongue coating, and a wiry and rapid pulse. Despite multiple treatments, the condition had not improved and had even worsened. An X-ray barium meal examination diagnosed acute gastritis. The syndrome was identified as cold stagnation transforming into heat, with qi stagnation and phlegm coagulation. The treatment principle was to purge fire and eliminate phlegm, regulate qi, and relieve depression. The prescribed formula was a modified Middle-Clearing Decoction: Pinellia 10g, Dried Tangerine Peel 10g, White Poria 10g, Alpinia Seed 6g, Gardenia 12g, Coptis Rhizome 10g, Bupleurum 10g, Aucklandia Root 6g, Liquorice Root 5g, and Fresh Ginger Rhizome 5g. After taking one dose, the pain significantly reduced. Continuing with five more doses of the same formula led to a complete recovery. A one-year follow-up showed no recurrence of the condition. [Hunan Journal of Traditional Chinese Medicine, 195, 11(2): 21~22]