1. Prescription Source & History

1. Qing Yan Li Ge Tang Origin Background

 Qing yan Li ge Decoction It is mainly from the famous medical masterpiece "Wanbing Huichun" written by Gong Tingxian, a renowned doctor in the Ming Dynasty. Gong Tingxian was a highly influential clinical scientist in the Ming Dynasty, and the prescriptions he created were known for "strong pertinence and quick effects". This prescription was widely spread in the society of the Ming Dynasty and mainly targeted the febrile diseases such as "Houbi" (similar to modern acute pharyngitis and tonsillitis) with rapid onset and severe symptoms at that time. The "Qingyan" in the prescription name directly points out the treatment site, while "Lige" implies the profound theory of traditional Chinese medicine that "treating the upper part must first dredge the lower part". By dredging the accumulated heat in the intestines and stomach under the diaphragm, it achieves the purpose of guiding the fire downward and clearing and relieving the throat fundamentally.

2. Historical Evolution

In terms of medical logic and prescription structure, Qingyan Lige Decoction fully embodies the characteristics of "clearing the upper part and purging the lower part, treating both internally and externally". This prescription combines drugs for dispersing wind-heat (such as Schizonepeta tenuifolia, Saposhnikovia divaricata, Mentha haplocalyx) and drugs for clearing heat with bitter-cold properties (such as Forsythia suspensa, Scutellaria baicalensis, Coptis chinensis, Gardenia jasminoides), and is combined with medicinal materials with the effect of dredging downward such as Rheum officinale and Natrii Sulfas.

This compatibility idea can not only disperse exogenous wind-heat from the body surface, but also purge the accumulated fire in the intestines and stomach from the inside. For the excess-heat syndrome with severely swollen and painful throat, even accompanied by constipation and oral ulcers, this "removing the fire from the bottom of the pot" prescription structure demonstrates the strong explosive power and accuracy of traditional Chinese medicine in dealing with acute inflammation. With the evolution of medical history, due to its definite curative effect, Qingyan Lige Decoction was included again in the medical masterpiece "Medical Prime of the Golden Mirror" compiled by the official in the Qing Dynasty and officially became a classic representative prescription in the otorhinolaryngology department of traditional Chinese medicine.

In the inheritance of hundreds of years, its application scope has been continuously expanded. It is not only used to treat acute throat swelling and pain, but also often used to assist in conditioning gum swelling and pain, oral ulcers and other diseases caused by excessive stomach fire. In modern clinical practice, this prescription still maintains its enduring value. It is often modified according to the specific constitution of patients and plays an irreplaceable role in anti-inflammatory and detumescence, and relieving acute respiratory inflammation.

2. Composition Introduction (King, Minister, Assistant, Guide)

1. King Drug

Forsythia suspensa: Forsythia suspensa has the effects of clearing heat and detoxifying, reducing swelling and dissipating nodules. As the monarch drug in Qingyan Lige Decoction, it can effectively clear the heat-toxin in the upper jiao and has a good therapeutic effect on symptoms such as throat swelling and pain, fever. Its nature is bitter and slightly cold, and it belongs to the lung, heart and small intestine meridians. It is good at dispersing wind-heat and expelling pathogenic factors, and is an important drug for treating throat heat-toxin.

Scutellaria baicalensis: Scutellaria baicalensis clears heat and dries dampness, purges fire and detoxifies, and is also an important part of the monarch drug. It can clear and drain the lung fire and has a strong effect of clearing the pathogenic fire in the throat area. The bitter-cold property of Scutellaria baicalensis is relatively strong, which can directly reduce the fire force and disperse the heat-toxin, thus relieving symptoms such as throat swelling and pain.

2. Minister Drug

Gardenia jasminoides: Gardenia jasminoides has the effects of purging fire to remove vexation, clearing heat and promoting diuresis, cooling blood and detoxifying. It can assist the monarch drug to enhance the power of clearing heat and purging fire, especially having a good conditioning effect on excessive fire in the triple energizer. In the Qingyan Lige Decoction, Gardenia jasminoides can further clear the heat toxin in the body, enabling the better dispersion of the heat toxin in the upper jiao, and alleviating the symptoms of swelling, heat, pain and redness in the throat area.

Mentha haplocalyx: Mentha haplocalyx disperses wind-heat, clears the head and eyes, and benefits the throat and promotes eruption. It can ascend to the head and eyes and descend to the blood sea, having a good dispersing effect. In this formula, Mentha haplocalyx can make the drugs better exert the effect of dispersing wind-heat, enabling the pathogenic factor of heat toxin to be resolved from the exterior. At the same time, it can relieve the discomfort in the throat area, play the role of benefiting the throat, and enhance the overall dispersing power of the formula.

3. Assistant Drug

Saposhnikovia divaricata: Saposhnikovia divaricata has the functions of expelling wind and relieving exterior syndrome, eliminating dampness and relieving pain, and stopping convulsions. It can expel wind pathogens, preventing the wind pathogens from lingering in the throat area and preventing the further development of the disease. At the same time, Saposhnikovia divaricata can harmonize all the drugs, enabling the drugs in the formula to better cooperate and play their roles, avoiding mutual conflicts between drugs, and playing the harmonizing effect of the adjuvant drug.

Schizonepeta tenuifolia: Schizonepeta tenuifolia relieves exterior syndrome and disperses wind, promotes eruption and eliminates carbuncles. It can enhance the dispersing effect of the formula and help disperse the pathogenic factor of wind-heat. The combination of Schizonepeta tenuifolia and Mentha haplocalyx can better exert the effect of dispersing wind-heat, enabling the pathogenic factor of heat toxin to come out from the muscular surface, and alleviating symptoms such as sore throat, playing the role of assisting the monarch drug and ministerial drug in the formula.

4. Guide Drugs (Platycodon, Licorice)

Platycodon grandiflorum: Platycodon grandiflorum promotes the dispersing function of the lung, soothes the throat, resolves phlegm, and discharges pus. It can carry drugs upward, enabling the medicinal power to directly reach the throat area and better exert its therapeutic effect. As an envoy drug, Platycodon grandiflorum guides other drugs to act on the affected area, enhances the targeted therapeutic effect of the formula on throat diseases, and can also regulate the qi of the lung, helping to improve the unsmooth qi movement in the throat.

Licorice Root: Licorice Root invigorates the spleen and replenishes qi, moistens the lung and relieves cough, clears heat and detoxifies, and harmonizes all the drugs. In Qingyan Lige Decoction, Licorice Root can not only harmonize the properties of other drugs, making the compatibility of the formula more coordinated, but also relieve symptoms such as sore throat, playing an auxiliary role in moistening the lung and relieving cough, clearing heat and detoxifying. It is an indispensable envoy drug in the formula.

III. Pathogenesis, Effects and Indications

1. Pathogenesis

The pathogenesis targeted by Qingyan Lige Decoction is mainly the intense heat-toxin in the upper jiao. Due to exogenous wind-heat pathogen invading the lung-defense, or overeating spicy, fatty, sweet, and rich foods, generating internal dampness-heat, heat-toxin accumulates in the throat area. The heat-toxin blocks the channels and collaterals in the throat, and the qi and blood circulation is unsmooth, thus presenting symptoms such as sore throat, swelling, redness, and heat pain. At the same time, the heat-toxin may also disturb the mind, causing systemic symptoms such as fever and restlessness.

2. Effects

3. Indications

Sore throat: Whether it is the sore throat caused by acute pharyngitis, tonsillitis, etc., or the swelling, redness, and heat pain caused by the accumulation of heat-toxin in the throat, Qingyan Lige Decoction has a good therapeutic effect. It can quickly relieve the symptom of sore throat and alleviate the pain of the patient.

Mouth and tongue ulcers: For oral ulcers caused by the upward attack of heat-toxicity, Qingyan Lige Decoction can clear heat and resolve toxicity, disperse wind-heat, so as to remove the pathogenic factor of heat-toxicity and promote the healing of oral ulcers.

Swollen and painful gums: Swollen and painful gums are mostly caused by the upward inflammation of stomach fire or the accumulation of heat-toxicity. Qingyan Lige Decoction can clear and drain the heat-toxicity in the upper jiao, and also has a certain therapeutic effect on swollen and painful gums, which can relieve the redness, swelling and pain in the gum area.

IV. Analysis of Qingyan Lige Decoction

1. Synergistic Effect of Heat-Clearing and Toxicity-Resolving Herbs

Heat-clearing and toxicity-resolving herbs such as Forsythia suspensa, Scutellaria baicalensis, and Gardenia jasminoides cooperate with each other to comprehensively remove the heat-toxicity in the upper jiao. Forsythia suspensa is good at dispersing wind-heat and expelling pathogenic factors outward. Scutellaria baicalensis clears and drains the lung fire. Gardenia jasminoides purges fire and relieves restlessness. The three work together to make the heat-toxicity have nowhere to hide, cutting off the generation and development path of heat-toxicity from multiple angles, so as to achieve the purpose of clearing heat and resolving toxicity.

2. Combination of Wind-Expelling and Heat-Dispersing Herbs

Wind-dispersing herbs such as Mentha haplocalyx, Schizonepeta tenuifolia, and Saposhnikovia divaricata work together synergistically to enhance the dispersing power of the formula. Mentha haplocalyx clears the head and eyes, benefits the throat and promotes eruption. Schizonepeta tenuifolia relieves exterior syndrome and disperses wind, promotes eruption and eliminates carbuncles. Saposhnikovia divaricata dispels wind and relieves exterior syndrome, eliminates dampness and relieves pain. Their combination enables the pathogenic factor of wind-heat to be quickly resolved from the muscle surface, preventing the further internal invasion of heat-toxicity, and also helps to relieve the discomfort symptoms in the throat caused by the invasion of wind-heat.

3. Mechanism of Throat-Soothing Herbs

Platycodon grandiflorum promotes the lung qi and benefits the throat. Glycyrrhiza uralensis moistens the lung, detoxifies and benefits the throat. The two are crucial for relieving sore throat. Platycodon grandiflorum can carry the herbs upward, making the medicinal power reach the affected area of the throat directly and enhancing the effect of the medicine on the throat. Glycyrrhiza uralensis directly relieves the redness, swelling and pain in the throat through moistening the lung and relieving cough, clearing heat and resolving toxicity. At the same time, it can also harmonize all the herbs, making the property of the formula more mild and convenient for patients to take.

4. Synergistic Effects of Overall Compatibility

The monarch herb, ministerial herbs, adjuvant herbs, and envoy herbs in the formula cooperate with each other and work synergistically. The monarch herb clears heat and resolves toxicity. The ministerial herbs assist the monarch herb to enhance the power of clearing heat and purging fire. The adjuvant herbs dispel wind pathogens and harmonize all the herbs. The envoy herb guides the medicinal power to reach the affected area directly and regulates the property of the medicine. This overall compatibility enables Qingyan Lige Decoction to effectively remove the heat-toxicity in the upper jiao, disperse wind-heat, relieve sore throat and swelling, achieving the effect of treating both the symptoms and the root cause, and comprehensively regulating various diseases caused by the heat-toxicity in the upper jiao.

V. Comparison with Other Similar Prescriptions

1. Comparison with Yinqiao Powder

Composition differences: Yinqiao Powder is mainly composed of Flos Lonicerae, Fructus Forsythiae, Herba Menthae, Herba Schizonepetae, Radix Platycodonis, Fructus Arctii, Folium Bambusae, Rhizoma Phragmitis, Semen Sojae Praeparatum, and Radix Glycyrrhizae; Qingyan Lige Decoction is based on Yinqiao Powder and added with drugs such as Radix Scutellariae, Fructus Gardeniae, and Radix Saposhnikoviae.

Emphasis on efficacy: Yinqiao Powder focuses on dispersing the exterior with pungent-cool herbs and clearing heat and detoxifying, mainly used for treating exterior syndrome of wind-heat invasion; on the basis of clearing heat and detoxifying and dispersing wind-heat, Qingyan Lige Decoction emphasizes more on relieving sore throat and reducing swelling, and has a more prominent therapeutic effect on upper-jiao heat-toxin symptoms such as sore throat.

Applicable diseases and syndromes: Yinqiao Powder is applicable to the initial stage of exterior syndrome of wind-heat invasion with symptoms such as fever, slightly aversion to wind-cold, headache, and sore throat; Qingyan Lige Decoction is mainly used for treating diseases with heat-toxin accumulating in the throat such as sore throat and aphtha.

2. Comparison with Huanglian Jiedu Decoction

Drug composition: Huanglian Jiedu Decoction is composed of Rhizoma Coptidis, Radix Scutellariae, Cortex Phellodendri, and Fructus Gardeniae; Qingyan Lige Decoction also contains Radix Scutellariae and Fructus Gardeniae, but also combined with drugs for dispersing wind-heat such as Fructus Forsythiae, Herba Menthae, Herba Schizonepetae, and Radix Saposhnikoviae, as well as throat-relieving drugs such as Radix Platycodonis and Radix Glycyrrhizae.

Characteristics of efficacy: Coptis Chinensis Detoxification Decoction mainly focuses on purging fire and detoxifying, with an emphasis on clearing the fire of the triple energizer; Qingyan Lige Decoction, in addition to clearing heat and detoxifying, also has the effects of dispersing wind-heat, relieving sore throat and reducing swelling, and pays more attention to the comprehensive regulation of heat-toxin in the upper-jiao and exogenous wind-heat.

Clinical application: Coptis Chinensis Detoxification Decoction is commonly used to treat the syndrome of excessive fire-toxin heat in the triple energizer, such as high fever and restlessness, dry mouth and throat, incoherent speech and insomnia; Qingyan Lige Decoction is mainly targeted at the upper-jiao heat-toxin diseases such as sore throat and aphthae, especially suitable for patients with symptoms of exogenous wind-heat.

VI. Clinical Applications and Indications

1. Acute Pharyngitis

Symptom manifestations: The onset is relatively acute. At the beginning, the pharynx is dry and burning, and then pain occurs, which is aggravated when swallowing. It may be accompanied by systemic symptoms such as fever, aversion to cold, headache, etc. The pharyngeal mucosa shows diffuse congestion, and the lymphoid follicles in the posterior pharyngeal wall proliferate.

Basis for application: Acute pharyngitis is mostly caused by exogenous wind-heat pathogen or exuberant heat in the lung and stomach. Qingyan Lige Decoction has the effects of clearing heat and detoxifying, dispersing wind-heat, can effectively clear the heat-toxin in the throat, relieve pain, reduce inflammation, and at the same time disperse the exogenous wind-heat pathogen and improve systemic symptoms.

2. Acute Tonsillitis

Symptom manifestations: Severe sore throat, difficulty in swallowing, accompanied by systemic symptoms such as high fever, chills, headache, etc. The tonsils are red and swollen, and there may be punctate or patchy purulent secretions on the surface.

Basis for application: Acute tonsillitis is mainly due to the accumulation of heat-toxicity in the throat. Qingyan Lige Decoction can quickly clear heat and detoxify, relieve sore throat and reduce swelling. By clearing heat-toxicity, it can alleviate the redness, swelling and pain of the tonsils, promote the subsidence of inflammation, and has a good therapeutic effect on acute tonsillitis.

3. Sore Throat with Fever

Symptom manifestations: The sore throat is obvious, accompanied by fever, the body temperature can reach 38°C or even higher, and may be accompanied by symptoms such as headache, body ache, thirst, etc.

Basis for application: This condition is mostly caused by exogenous wind-heat pathogens invading the throat. Qingyan Lige Decoction can not only disperse wind-heat, relieve the heat-toxicity pathogens from the exterior, reduce body temperature, but also clear heat and detoxify, relieve sore throat and reduce swelling, relieve the symptoms of sore throat, treating both the symptoms and the root cause, and has a good curative effect on such diseases.

VII. Modified Qingyan Lige Decoction

VIII. Dosage (Traditional & Concentrated Granules)

IX. Precautions & Taboos

1. Dietary Taboos

During the period of taking medicine, spicy, greasy and stimulating foods should be avoided, such as chili peppers, fried foods, scallions, ginger and garlic. These foods are likely to exacerbate the heat-toxicity in the body, which is not conducive to the recovery of the illness and may even lead to the aggravation of symptoms such as sore throat. Alcohol should not be consumed, as alcohol will stimulate the mucosa of the throat, affect the therapeutic effect of the medicine and may also exacerbate the illness.

2. Special Populations Note

Caution for pregnant women: Some drugs in Qingyan Lige Decoction, such as Scutellaria baicalensis and Gardenia jasminoides, have certain cold properties. The physical constitution of pregnant women is relatively special, and excessive use may have an adverse impact on the fetus. Therefore, pregnant women should use it cautiously under the guidance of a doctor. Use with caution for those with spleen and stomach yang deficiency: Those with spleen and stomach yang deficiency have relatively weak spleen and stomach functions. Most of the drugs in Qingyan Lige Decoction are cold-natured products, which may damage the yang qi of the spleen and stomach, leading to aggravation of symptoms of spleen and stomach yang deficiency, such as abdominal pain and diarrhea. Therefore, it should be used with caution. If it must be used, some drugs for warming yang and strengthening the spleen can be appropriately added to the formula for compatibility.

3. Condition Observation

During the period of taking Qingyan Lige Decoction, the changes in the condition should be closely observed. If symptoms such as sore throat persist without relief or worsen, and the fever does not subside, medical treatment should be sought in a timely manner and the treatment plan should be adjusted. Pay attention to observing the reactions after taking the medicine, such as whether adverse reactions such as nausea, vomiting, and diarrhea occur. If discomfort symptoms appear, the doctor should be informed in a timely manner so that corresponding measures can be taken.

Ten. Modern Research Progress

1. Pharmacological Research

Function of clearing heat and detoxifying: Modern research shows that drugs such as Forsythia suspensa, Scutellaria baicalensis, and Gardenia jasminoides in Qingyan Lige Decoction have antibacterial, antiviral, anti-inflammatory and other effects. Components such as phillyrin in Forsythia suspensa can inhibit the growth and reproduction of various bacteria and viruses. Baicalin in Scutellaria baicalensis has anti-inflammatory and anti-allergic effects. Geniposide in Gardenia jasminoides can reduce inflammatory reactions. All of these are for Qingyan Lige Decoction It provides a scientific basis for the effects of clearing heat and detoxifying, relieving sore throat and reducing swelling. Immunomodulatory effect: Some drugs in the formula also have immunomodulatory effects. For example, licorice can regulate the immune function of the body, enhance the resistance of the body, help to eliminate pathogens in the body, and promote the recovery of diseases.

2. Clinical Research

In clinical practice, more and more studies have confirmed the effectiveness of Qingyan Lige Decoction in the treatment of throat diseases. A number of clinical observations have shown that Qingyan Lige Decoction can significantly relieve symptoms such as sore throat, fever, etc., shorten the course of disease, and improve the cure rate. For diseases such as acute pharyngitis and acute tonsillitis, its curative effect is better than some simple western medicine treatments. Some studies have also improved and optimized the dosage form of Qingyan Lige Decoction, such as making it into granules, oral liquids, etc., which are convenient for patients to take, and at the same time improve the stability and curative effect of the drug. These modern research progress provide strong support for the further promotion and application of Qingyan Lige Decoction.

Summary of Qingyan Lige Decoction

Qing yan Li ge Decoction is a commonly used formula for treating throat swelling and pain such as acute pharyngolaryngitis and herpangina, which comes from medical books such as 'Complete Collection of Diphtheria'. This formula clears heat and purges fire, detoxifies, and purges heat and promotes defecation. It is applicable to full throat swelling and redness, throat pain, difficulty in swallowing food, discomfort in speaking, excessive phlegm, as well as restlessness, red eyes and restlessness, aversion to heat with a light body, gradually increasing heat, accumulated heat, constipation (difficult or unsmooth defecation), deep yellow tongue coating and other syndromes. Clinically, it is often modified and added based on Coptis Detoxification Decoction and Yinqiao Powder. The medicinal materials include arctium (fried with ginger juice), scrophularia, platycodon grandiflorum, mentha haplocalyx, forsythia suspensa, gardenia jasminoides (fried with wine), schizonepeta tenuifolia, ledebouriella seseloides, coptis chinensis, rheum officinale, licorice, etc. It is decocted in water for oral administration and has a significant curative effect on those with heat-toxin accumulated in the throat.