1. Prescription Source & History

1. Origin of Chaihu Shugan San

Bupleurum Liver-Dispersing Powder originated from Complete Works of Jingyue written by Zhang Jingyue, a medical expert in the Ming Dynasty. Zhang Jingyue made outstanding contributions to medicine. He attached great importance to the theory of yin and yang and emphasized the academic view that "yang is not excessive, while yin is often insufficient". Bupleurum Liver-Dispersing Powder was created based on his profound medical theory. Its establishment aims to regulate the qi mechanism of the human body and provide an effective treatment formula for a series of diseases caused by emotional discomfort and stagnation of liver qi.

2. Historical Inheritance & Development

Since its birth in the Ming Dynasty, Bupleurum Liver-Dispersing Powder has experienced hundreds of years of inheritance and application. Physicians of past dynasties have continuously verified its efficacy in clinical practice and adjusted and improved the formula according to the actual situation. With the development of medicine, it has gradually become one of the classic formulas for treating liver qi stagnation syndrome in traditional Chinese medicine, widely used in the treatment of various liver depression-related diseases, relieving pain for many patients, and occupying an important position in the development of traditional Chinese medicine formula science.

2. Introduction to Ingredients (King, Minister, Assistant, Guide)

1. King Herb - Bupleurum

Bupleurum is the dried root of Bupleurum chinense DC. or Bupleurum scorzonerifolium Willd. of the Umbelliferae family. It is slightly cold in nature, pungent and bitter in taste, and belongs to the liver and gallbladder meridians. Bupleurum has the effects of inducing sweating to relieve exterior syndrome, dispersing liver qi to relieve depression, and lifting yang qi. In Bupleurum Liver-Dispersing Powder, it serves as the monarch drug and plays a core role in dispersing liver qi to relieve depression. It can regulate the liver qi, making the liver qi smooth and unobstructed, no longer stagnant, just like解开了肝郁之结, which is the key to treating liver qi stagnation.

2. Minister Herbs - Cyperus, Chuanxiong

Cyperus rotundus is the dried rhizome of Cyperus rotundus L. of the Cyperaceae family. It is pungent, slightly bitter, slightly sweet in taste, flat in nature, and belongs to the liver, spleen, and triple energizer meridians. It has the functions of dispersing liver qi to relieve depression, regulating qi to relieve distension, and regulating menstruation to stop pain. It can enhance the effect of Bupleurum in dispersing liver qi and regulating qi, and assist Bupleurum to better regulate the liver qi, making the qi mechanism smooth.

Chuanxiong is the dried rhizome of Ligusticum chuanxiong Hort. of the Umbelliferae family. It is pungent in taste and warm in nature, and belongs to the liver, gallbladder, and pericardium meridians. It has the effects of promoting blood circulation and regulating qi, dispelling wind and relieving pain. It can promote qi movement in blood, cooperate with Bupleurum and Cyperus rotundus, strengthen the effects of dispersing liver qi and regulating qi, promoting blood circulation and dredging collaterals, making the qi and blood flow smoothly, and relieving the symptoms of qi and blood stagnation caused by liver qi stagnation. Cyperus rotundus and Chuanxiong jointly assist Bupleurum and enhance the effect of dispersing liver qi and regulating qi.

3. Assistant Herbs - Tangerine Peel, Aurantii Fructus Immaturus, Paeonia

Tangerine peel is the dried mature pericarp of Citrus reticulata Blanco and its cultivated varieties of the Rutaceae family. It is pungent and bitter in taste, warm in nature, and belongs to the spleen and lung meridians. It can regulate qi and strengthen the spleen, dry dampness and resolve phlegm. In Bupleurum Liver-Dispersing Powder, it can regulate qi and harmonize the middle, assist the monarch and minister drugs to regulate the qi mechanism, prevent the liver qi from invading the stomach, and play an adjuvant role.

Fructus Aurantii is the dried immature fruit of Citrus aurantium L. and its cultivated varieties of the Rutaceae family. It is bitter, pungent, and sour in taste, slightly cold in nature, and belongs to the spleen and stomach meridians. It has the effects of promoting qi circulation to open the chest and relieving distension in the middle. It can enhance the power of regulating qi, act synergistically with other drugs, and strengthen the regulation of qi stagnation.

Paeonia lactiflora is the dried root of Paeonia lactiflora Pall. of the Ranunculaceae family. It is bitter and sour in taste, slightly cold in nature, and belongs to the liver and spleen meridians. It has the functions of nourishing blood and regulating menstruation, astringing yin and stopping sweating, soothing the liver and relieving pain, and suppressing liver yang. Here, it can nourish the blood and soothe the liver, relieve spasm and pain, prevent the liver qi from being too exuberant and attacking the spleen earth, and at the same time relieve symptoms such as hypochondriac pain caused by liver qi stagnation, playing multiple roles of adjuvant drugs.

4. Guide Herb - Licorice

Licorice is the dried root and rhizome of Glycyrrhiza uralensis Fisch., Glycyrrhiza inflata Bat. or Glycyrrhiza glabra L. It is sweet in flavor and neutral in property, and belongs to the Heart, Lung, Spleen, and Stomach meridians. It has the effects of invigorating the spleen and replenishing qi, moistening the lungs and relieving cough, clearing heat and detoxifying, and coordinating various herbs. In Chaihu Shugan San, licorice coordinates various herbs, enabling them to work together more effectively, while also alleviating the toxicity and potency of the herbs, protecting the spleen and stomach, and preventing the entire formula from damaging healthy qi while attacking pathogenic factors.

III. Pathogenesis, Efficacy and Indications

1. Pathogenesis

The main pathogenesis targeted by Chaihu Shugan San is stagnation of liver qi. Uncomfortable emotions, such as long-term depression, anger, and annoyance, can lead to abnormal dispersing and discharging functions of the liver, resulting in stagnation of liver qi. After the stagnation of liver qi, the qi mechanism is not smooth, which further affects the circulation of qi and blood, and symptoms such as distending pain in the hypochondrium and chest discomfort may occur. If liver depression persists for a long time, it may also invade the stomach horizontally, leading to disharmony of the spleen and stomach functions, manifested as loss of appetite, abdominal distension, etc. In addition, qi stagnation and blood stasis can cause symptoms such as fixed pain in the pain area and stabbing pain.

2. Efficacy

Based on the above pathogenesis, Chaihu Shugan San has the effects of soothing the liver and regulating qi, promoting blood circulation and relieving pain. By using herbs such as Bupleurum chinense DC. and Cyperus rotundus L. to soothe the liver and relieve depression, the liver qi can be smoothed; Ligusticum wallichii Franch. promotes blood circulation to remove blood stasis and unblocks qi and blood; Citrus reticulata Blanco and Aurantii Fructus Immaturus regulate qi and relieve distension, Paeonia lactiflora Pall. nourishes the blood and soothes the liver to relieve pain, and licorice coordinates various herbs. Working together, they achieve the purpose of soothing the liver and regulating qi, promoting blood circulation and relieving pain, enabling the qi mechanism of the human body to return to normal, and the qi and blood to circulate smoothly, thus alleviating various discomfort symptoms caused by stagnation of liver qi.

3. Indications

Chaihu Shugan San is mainly used to treat the syndrome of stagnation of liver qi. Common symptoms include pain in the hypochondrium, chest distress with frequent sighing, emotional depression or irritability, abdominal distension and fullness, and a taut pulse. These symptoms are mostly induced by emotional factors or aggravated when the emotions are不畅. The pain in the hypochondrium can manifest as distending pain, shooting pain or stabbing pain, and the pain location is uncertain, closely related to emotional changes. Chest distress with frequent sighing is a typical manifestation of stagnation of liver qi and不畅 qi mechanism. Patients often unconsciously take deep breaths to relieve the feeling of chest distress. Emotional depression or irritability directly reflects the impact of stagnation of liver qi on emotions. Abdominal distension and fullness are the result of the liver qi invading the stomach horizontally, leading to stagnation of qi in the spleen and stomach. A taut pulse is also a common pulse manifestation of stagnation of liver qi.

IV. Analysis of Chaihu Shugan Powder

1. Soothing liver qi as the main line

In Chaihu Shugan San, Bupleurum chinense DC. is used as the monarch herb to soothe the liver and relieve depression, which is the core of the formula. Cyperus rotundus L. and Ligusticum wallichii Franch. are used as ministerial herbs to enhance the power of soothing the liver and regulating qi. The three herbs work together around the main line of soothing the liver and regulating qi, targeting the pathogenesis of stagnation of liver qi, and fundamentally regulating the dispersing and discharging functions of the liver, enabling the liver qi to flow smoothly and orderly.

2. Treating qi and blood together

While regulating the qi mechanism, Ligusticum wallichii Franch. is added to promote blood circulation to remove blood stasis in the formula. Because stagnation of liver qi is likely to lead to qi stagnation and blood stasis, and qi and blood affect each other. By promoting blood circulation, it can further promote the smooth flow of qi mechanism, making qi move and blood move, and blood move and qi flow smoothly, achieving the effect of treating both qi and blood simultaneously, and better relieving symptoms of qi and blood stagnation such as pain in the hypochondrium caused by stagnation of liver qi.

3. Regulating spleen and stomach (FD)

Citrus reticulata Blanco and Aurantii Fructus Immaturus regulate qi and harmonize the middle, preventing the liver qi from invading the stomach and regulating the qi mechanism of the spleen and stomach. Paeonia lactiflora Pall. nourishes the blood and soothes the liver, relieving spasm and pain, and can also prevent the overactive liver qi from attacking the spleen earth, protecting the functions of the spleen and stomach. Licorice coordinates various herbs, and also tonifies the spleen and stomach, enabling the entire formula to soothe the liver and regulate qi without damaging the healthy qi of the spleen and stomach, reflecting the idea of overall regulation and protecting the spleen and stomach in traditional Chinese medicine.

V. Comparison with Other Similar Formulas

1. Comparison with Xiaoyao San

Xiaoyao San It is from 'Taiping Huimin Heji Jufang' and its main effects are soothing the liver and relieving depression, nourishing blood and strengthening the spleen. Compared with Chaihu Shugan San, Xiaoyao San focuses more on nourishing blood and strengthening the spleen and is applicable to the syndrome of liver depression with blood deficiency and spleen weakness. In its composition, in addition to drugs for soothing the liver and nourishing blood such as Chaihu, Baishao, and Danggui, there are also drugs for strengthening the spleen such as Baizhu, Fuling, and Gancao to achieve the purpose of regulating both the liver and the spleen. While Chaihu Shugan San focuses more on soothing the liver, regulating qi and promoting blood circulation to relieve pain, and is more targeted at liver qi stagnation. There are relatively fewer drugs for strengthening the spleen in its composition and it mainly regulates liver qi.

2. Comparison with Sini San

Sini San It is from 'Treatise on Febrile Diseases' and its effects are dispersing pathogenic factors and relieving depression, soothing the liver and regulating the spleen. It is mainly used for the syndrome of yang stagnation and reversal cold or the syndrome of liver and spleen qi stagnation. Compared with Chaihu Shugan San, the drug composition of Sini San is more concise, consisting only of four drugs: Chaihu, Shaoyao, Zhishi, and Gancao. Its power of soothing the liver and regulating qi is relatively weak and it focuses on dispersing pathogenic factors and relieving depression. By smoothing the qi mechanism, yang qi can be dredged. Chaihu Shugan San is more comprehensive in soothing the liver and regulating qi. It can not only soothe the liver and relieve depression, but also promote blood circulation to relieve pain. Its drug composition is more abundant and it is more extensive in treating the symptoms of liver qi stagnation.

VI. Clinical Applications and Indications

1. Digestive System Diseases

Chaihu Shugan San It is widely used in digestive system diseases. For epigastric pain of the liver qi stagnation type, patients often show distending pain in the epigastrium, which radiates to both flanks and is aggravated when the emotions are not smooth, accompanied by symptoms such as belching and acid reflux. Chaihu Shugan San can soothe the liver and regulate qi, harmonize the stomach and relieve pain, and relieve the distending pain and discomfort in the epigastrium. For hypochondriac pain of the liver qi stagnation type, there is distending pain or shooting pain in the hypochondriac region, and the pain changes with emotional fluctuations. Using Chaihu Shugan San can effectively soothe the liver and relieve depression, regulate qi and relieve pain, and relieve the symptoms of hypochondriac pain. In addition, for indigestion, loss of appetite and other conditions caused by liver qi stagnation resulting in disharmony of the spleen and stomach functions, it also has a good conditioning effect.

2. Mental and Nervous System Diseases

In the aspect of the mental and nervous system Chaihu Shugan San can be used to treat emotional diseases such as depression and anxiety caused by liver qi stagnation. Patients often show symptoms such as low mood, melancholy, anxiety, restlessness, and insomnia and dreaminess. Chaihu Shugan San soothes the liver and regulates qi, regulates emotions, improves the mental state of patients, relieves depression and anxiety emotions, and improves the quality of sleep. For headache caused by liver qi stagnation, especially migraine, the pain location is mostly related to the circulation of the Liver Meridian. Chaihu Shugan San can soothe the liver and regulate qi, dredge the channels and relieve pain, and relieve the headache symptoms.

3. Gynecological Diseases

In the field of gynecology, Chaihu Shugan San is commonly used to treat irregular menstruation of the liver qi stagnation type. The patient's menstrual cycle may be early or delayed, the menstrual volume may be more or less, the menstrual color is dull red, accompanied by symptoms such as breast distending pain and hypochondriac pain. Chaihu Shugan San can soothe the liver and regulate qi, regulate the thoroughfare and conception vessels, make qi and blood unobstructed, thus improving the symptoms of irregular menstruation. It also has a good effect on breast distending pain before menstruation caused by liver qi stagnation, can relieve breast distending pain discomfort, and make the patient more comfortable during menstruation.

VII. Modifications

1. Those with severe pain

Yanhusuo (Rhizoma Corydalis) and Yujin (Turmeric) can be added to enhance the power of promoting blood circulation to remove stasis and relieve pain. Yanhusuo can promote qi stagnation in blood and blood stagnation in qi, and specifically treat various pains in the whole body. Adding it to the formula can effectively relieve various pain symptoms such as hypochondriac pain and epigastric pain. Yujin can promote blood circulation to remove stasis and relieve pain, promote qi movement to relieve depression, clear the heart and cool the blood, and promote bile secretion and remove jaundice. Acting synergistically with Yanhusuo, it further enhances the analgesic effect and better controls the pain symptoms.

2. Qi stagnation with blood stasis

Danshen (Salvia miltiorrhiza), Taoren (Peach Kernel), Honghua (Safflower) and other drugs for promoting blood circulation to remove stasis can be added. Danshen has the effects of promoting blood circulation to remove stasis, dredging meridians to relieve pain, clearing the heart to remove vexation, and cooling the blood to eliminate carbuncles. Taoren can promote blood circulation to remove stasis and moisten the intestines to relieve constipation. Honghua can promote blood circulation to dredge meridians and disperse stasis to relieve pain. The addition of these drugs can enhance the effect of promoting blood circulation to remove stasis in the formula, more effectively treat the syndrome of qi stagnation and blood stasis, and improve symptoms such as pain and mass caused by blood stasis.

3. Liver depression turning to fire

Mudanpi (Cortex Moutan) and Zhizi (Fructus Gardeniae) can be added to clear heat and purge fire. Mudanpi can clear heat and cool the blood and promote blood circulation to remove stasis. Zhizi can purge fire to remove vexation, clear heat and promote diuresis, and cool the blood to detoxify. When liver qi transforms into fire, the patient may present symptoms such as bitter taste in the mouth, dry throat, irritability, and hypochondriac pain with a burning sensation. After adding Mudanpi and Zhizi, it can clear the stagnant fire in the liver meridian, relieve the symptoms of fire transformation, and improve the patient's overall symptoms.

VIII. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional method

The traditional usage of Chaihu Shugan San is to decoct the medicinal slices with water. Generally, Bupleuri Radix 6g, Citri Reticulatae Pericarpium 6g, Chuanxiong Rhizoma 4.5g, Cyperi Rotundi Rhizoma 4.5g, Aurantii Fructus Immaturus 4.5g, Paeoniae Radix Alba 4.5g, Glycyrrhizae Radix et Rhizoma 1.5g. Put these drugs into the pot, add an appropriate amount of clear water, soak for about 30 minutes, then decoct with a slow fire for 30 - 40 minutes, and take the decoction. One dose per day, taken twice, once in the morning and once in the evening. When taking it, it is advisable to take it warm to help the efficacy of the medicine play.

2. Modern concentrated granules

Modern concentrated granules are granule preparations made from traditional Chinese medicines through processes such as extraction and concentration. It is more convenient to take, just need to be taken with boiling water. Its dosage corresponds to that of traditional slices. Generally, it is also made into concentrated granules according to the above drug ratio. Each time of taking is equivalent to the dosage of traditional slices. Similarly, one dose per day, taken twice. Modern concentrated granules retain the effective components of traditional Chinese medicines, and are convenient to take, suitable for the modern fast-paced lifestyle, providing more choices for patients.

IX. Precautions and Taboos

1. Emotional regulation

During the period of taking Chaihu Shugan San, the patient should pay attention to emotional regulation. Keep the mood comfortable, avoid excessive emotional fluctuations, such as bad emotions like anxiety, depression, anger, etc. Because emotional factors are important causes leading to liver qi stagnation. If emotional regulation is not paid attention to, even if taking medicine, it may affect the treatment effect and cause the disease to relapse.

2. Dietary Taboos

Spicy, greasy, and stimulating foods such as chili peppers, fried foods, coffee, and strong tea should be avoided. These foods are likely to加重 the burden on the spleen and stomach, affect the transportation and transformation functions of the spleen and stomach, and are not conducive to the dredging of liver qi. At the same time, smoking and alcohol should be quit to avoid damaging the liver and spleen. Some foods with the function of soothing the liver and regulating qi, such as fingered citron, citron, and rose flowers, can be appropriately added, which is helpful for the recovery of the disease.

3. Caution for Pregnant Women

Most of the herbs in Chaihu Shugan San are for regulating qi and activating blood circulation. Taking it during pregnancy may have adverse effects on the fetus, leading to restlessness of fetal movement and other conditions. Therefore, pregnant women should use Chaihu Shugan San with caution. If medication is needed, it should be carried out under the guidance of a doctor and used carefully after weighing the pros and cons.

X. Modern Research Progress

1. Pharmacological Action Research

According to the theory that the liver governs dredging and dispersing, symptoms such as breast distending pain, dysmenorrhea, and belching are likely to occur when liver qi is stagnated or liver depression and qi stagnation occur. Chaihu Shugan San is modified from Sini San and has the functions of soothing the liver and relieving depression, regulating qi in the liver, harmonizing the liver and spleen, promoting qi circulation and activating blood circulation, and promoting blood circulation to stop pain. The main herbs include Bupleurum chinense, White Peony Root (Paeonia lactiflora), Chuanxiong Rhizome, Cyperus rotundus, Immature Bitter Orange (Fructus Aurantii Immaturus), Licorice Root, etc. It is clinically applicable to syndromes such as chronic hepatitis, chronic gastritis, functional dyspepsia, breast hyperplasia, intercostal neuralgia, etc. Patients often have string-like pulses or alternate chills and fever. Licorice Root harmonizes all the herbs. Modern research shows that Chaihu Shugan San has various pharmacological effects. In terms of its influence on the liver, it can regulate the metabolic function of the liver, promote the repair and regeneration of hepatocytes, and improve the blood circulation of the liver. In regulating emotions, it can act on the nervous system, regulate the secretion of neurotransmitters, and relieve emotions such as anxiety and depression. Its effect on the digestive system is manifested as promoting gastrointestinal peristalsis, increasing the secretion of digestive juices, improving digestive function, and relieving symptoms such as epigastric distending pain and dyspepsia. In addition, it also has anti-inflammatory, antioxidant and other effects, which helps to improve the body's immunity, reduce inflammatory reactions, and delay aging, etc.

2. Clinical Efficacy Verification

Numerous clinical studies have further verified the curative effect of Chaihu Shugan San. In the treatment of diseases such as epigastric pain, hypochondriac pain, and irregular menstruation of the type of liver depression and qi stagnation, compared with other treatment methods, Chaihu Shugan San can more effectively relieve symptoms and improve the quality of life of patients. For example, in a study on patients with epigastric pain of the type of liver depression and qi stagnation, after treatment with Chaihu Shugan San, the symptoms of epigastric distending pain in patients were significantly relieved, and the gastric mucosal lesions shown by gastroscopy also improved. In terms of mental and nervous system diseases, for patients with depression and anxiety caused by liver depression and qi stagnation, Chaihu Shugan San can significantly improve the emotional state of patients, reduce the scores of depression and anxiety symptoms, and improve the sleep quality of patients.