1. Source and History of Yinchenhao Decoction

1. Recorded in Classic Works

Yinchenhao Decoction comes from Treatise on Febrile Diseases written by Zhang Zhongjing in the Eastern Han Dynasty. As a classic of traditional Chinese medicine, Treatise on Febrile Diseases laid the foundation for syndrome differentiation and treatment in traditional Chinese medicine and had a profound impact on the development of later medicine. Yinchenhao Decoction is an important prescription for treating damp-heat jaundice among them.

Zhang Zhongjing observed and summarized a large number of clinical cases at that time, discovered the etiology, pathogenesis and corresponding treatment methods of the disease of damp-heat jaundice, and thus created Yinchenhao Decoction. This work expounded the diseases, treatment methods and application of prescriptions in the form of articles, providing the original basis for later medical practitioners to study and apply Yinchenhao Decoction.

2. Historical Evolution

Since Treatise on Febrile Diseases, Yinchenhao Decoction has been widely used in clinical treatment of jaundice-related diseases. Successive medical practitioners have continuously enriched and developed its application on the basis of inheriting Zhang Zhongjing's experience.

During the Wei, Jin, Southern and Northern Dynasties, medical practitioners began to further explore the compatibility changes of the drugs in Yinchenhao Decoction and the expansion of its scope of application. During the Sui and Tang dynasties, with the increase of medical exchanges, the application experience of Yinchenhao Decoction spread to surrounding areas.

During the Song, Jin and Yuan dynasties, new developments occurred in medical theory. Medical practitioners analyzed the prescriptions from different perspectives, and more explorations were made on Yinchenhao Decoction in treating concurrent syndromes of jaundice. During the Ming and Qing dynasties, the theory of epidemic febrile diseases emerged. Yinchenhao Decoction was also applied to the treatment of jaundice caused by epidemic febrile diseases, and more refined research was carried out in aspects such as drug processing and dosage adjustment.

In modern times, with the continuous progress of medical research methods, new achievements have been made in the clinical application and pharmacological research of Yinchenhao Decoction, and its scope of application is also constantly expanding.

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

1. King Drug - Yinchenhao

Artemisia capillaris Thunb. is the seedling of the perennial herb Artemisia capillaris Thunb. in the Asteraceae family. It tastes slightly bitter and pungent, and is slightly cold in nature. It belongs to the spleen, stomach, liver, and gallbladder meridians.

Artemisia capillaris Thunb. has the remarkable effect of clearing heat, promoting diuresis, and removing jaundice. It is good at clearing damp-heat in the spleen, stomach, liver, and gallbladder, and is an important herb for treating jaundice. Its active ingredients such as capillarisin and capillarin have the effect of promoting bile secretion, increasing the excretion of cholic acid and bilirubin in bile, thereby alleviating the symptoms of jaundice.

In the Yinchenhao Decoction, its dosage is the largest, reaching the affected area directly, targeting the core pathogenesis of jaundice - damp-heat accumulating in the liver and gallbladder, and playing a major role in clearing heat, promoting diuresis, and removing jaundice, so it is the monarch herb.

2. Minister Drug - Zhizi

Gardenia jasminoides Ellis is the dried ripe fruit of the plant Gardenia jasminoides Ellis in the Rubiaceae family. It tastes bitter and is cold in nature. It belongs to the heart, lung, and triple energizer meridians.

Gardenia jasminoides Ellis has the effects of purging fire to remove vexation, clearing heat and promoting diuresis, cooling blood and detoxifying. In the Yinchenhao Decoction, it assists Artemisia capillaris Thunb. to enhance the power of clearing heat and promoting diuresis. It can clear damp-heat in the triple energizer, making the damp-heat excrete through urine. At the same time, the bitter and cold nature of Gardenia jasminoides Ellis can enhance the effect of clearing heat and purging fire of the whole formula, helping to eliminate the heat pathogen factor that forms jaundice.

The components such as geniposide contained in Gardenia jasminoides Ellis can promote bile secretion, which has a positive effect on the subsidence of jaundice. It is combined with Artemisia capillaris Thunb., and the monarch and minister work together to strengthen the effect of clearing heat, promoting diuresis, and removing jaundice, so it is the minister herb.

3. Assistant Drug - Dahuang

Rheum palmatum L., Rheum tanguticum Maxim. ex Balf. or Rheum officinale Baill. is the dried root and rhizome of the plant Rheum palmatum L., Rheum tanguticum Maxim. ex Balf. or Rheum officinale Baill. in the Polygonaceae family. It tastes bitter and is cold in nature. It belongs to the spleen, stomach, large intestine, liver, and pericardium meridians.

Rheum palmatum L., Rheum tanguticum Maxim. ex Balf. or Rheum officinale Baill. has the effects of purging downward to relieve constipation, clearing heat and purging fire, cooling blood and detoxifying, removing blood stasis and dredging menstruation. In the Yinchenhao Decoction, Rheum palmatum L., Rheum tanguticum Maxim. ex Balf. or Rheum officinale Baill. mainly plays the role of purging downward. By promoting defecation, it provides an outlet for the damp-heat pathogen, achieving the purpose of eliminating the pathogen from both the front and the back.

Its purgative effect can promote the excretion of damp-heat toxins in the intestines and reduce the absorption of damp-heat. At the same time, the effect of clearing heat and purging fire of Rheum palmatum also helps to enhance the overall effect of clearing heat in the formula. It combines with Artemisia capillaris and Gardenia jasminoides, playing the role of assistant and assistant restraint, so it is an assistant drug.

4. Guide Drug - Gancao

Licorice is the dried root and rhizome of Glycyrrhiza glabra, Glycyrrhiza inflata or Glycyrrhiza glabra of Leguminosae family. It tastes sweet and is性平. It belongs to the heart, lung, spleen and stomach meridians.

Licorice has the effects of invigorating the spleen and replenishing qi, moistening the lung and relieving cough, clearing heat and detoxifying, and coordinating various drugs. In Yinchenhao Decoction, licorice mainly plays the role of coordinating various drugs. It can relieve the bitter-cold nature of Artemisia capillaris, Gardenia jasminoides and Rheum palmatum, making the property of the whole formula more mild and avoiding excessive harshness from damaging healthy qi.

At the same time, licorice can also invigorate the spleen and replenish qi, prevent the damage of healthy qi of the spleen and stomach by drugs for clearing dampness and promoting diuresis, and play a role in protecting the functions of the spleen and stomach. Therefore, licorice is a guiding drug in the formula.

Pathogenesis, Efficacy and Indications

1. Pathogenesis

The pathogenesis targeted by Yinchenhao Decoction is the accumulation of damp-heat in the spleen, stomach, liver and gallbladder. External contraction of damp-heat pathogen, or internal injury by diet, abnormal transportation and transformation of the spleen and stomach, endogenous production of damp turbidity, stagnation transforming into heat, damp-heat steaming the liver and gallbladder, bile not following the normal path, overflowing to the skin and causing jaundice.

The spleen and stomach are the foundation of acquired constitution, mainly responsible for the transportation and transformation of water and dampness. The invasion of damp-heat pathogen into the spleen and stomach leads to the disorder of the functions of the spleen and stomach, metabolic disorder of water and dampness, and endogenous production of damp pathogen. Dampness stagnates and transforms into heat, combining with damp-heat, steaming the liver and gallbladder. The dredging and discharging function of the liver and gallbladder is abnormal, and the excretion of bile is unsmooth, thus triggering jaundice.

2. Efficacy

Yinchenhao Decoction has the effect of clearing heat, promoting diuresis and relieving jaundice. In the formula, Artemisia capillaris for clearing heat, promoting diuresis and relieving jaundice is the monarch drug, Gardenia jasminoides for clearing heat and promoting diuresis, and Rheum palmatum for purging damp-heat. The three drugs are used together to achieve the effect of clearing heat and promoting diuresis, enabling the elimination of damp-heat pathogen and the subsidence of jaundice.

By clearing away damp-heat in the spleen, stomach, liver and gallbladder, regulating the dispersing and discharging functions of the liver and gallbladder, and promoting the normal excretion of bile, the purpose of reducing jaundice can be achieved.

3. Indications

Yinchenhao Decoction is mainly used to treat damp-heat jaundice. The symptoms include yellowing of the whole body, face and eyes, with a bright yellow color like that of oranges, fever, no sweating or only sweating on the head, thirst and desire to drink, nausea and vomiting, slightly full abdomen, short and red urine, unsmooth or constipated stools, red tongue, yellow and greasy tongue coating, and deep and rapid or slippery and rapid pulse.

Among them, the bright yellow color like that of oranges is a typical manifestation of damp-heat jaundice, caused by the steaming of damp-heat and the overflow of bile. Symptoms such as fever and thirst are signs of excessive internal heat, while short and red urine, unsmooth or constipated stools are manifestations of damp-heat pouring downward and abnormal intestinal conduction.

IV. Analysis of Formula Principles

1. Synergistic Effect of Clearing Heat and Promoting Diuresis

The three herbs, Yinchenhao, Gardenia Fruit and Rhubarb, all have the effect of clearing away heat and promoting diuresis, but each has its own emphasis. Yinchenhao mainly clears away damp-heat in the spleen, stomach, liver and gallbladder and is the key herb for reducing jaundice; Gardenia Fruit clears away damp-heat in the triple energizer and focuses on clearing away heat and promoting diuresis through urine; Rhubarb makes the pathogenic factors of damp-heat excrete through defecation by purging the stools.

When the three herbs are used together, the power of clearing away heat and promoting diuresis is synergistically enhanced, comprehensively clearing away the pathogenic factors of damp-heat in the body and enabling the jaundice to subside. This synergistic effect targets the pathogenesis of damp-heat jaundice and plays a therapeutic role through different channels, reflecting the subtlety of the compatibility of traditional Chinese medicine prescriptions.

2. Treating Zang-Fu Organs Simultaneously

Yinchenhao Decoction Through the compatibility of herbs, the simultaneous treatment of zang-fu organs such as the spleen, stomach, liver and gallbladder is achieved. Yinchenhao belongs to the spleen, stomach, liver and gallbladder meridians and directly acts on the diseased site to clear away damp-heat in the liver and gallbladder; Gardenia Fruit belongs to the heart, lung and triple energizer meridians, clears away damp-heat in the triple energizer and helps restore the transportation function of the spleen and stomach; Rhubarb belongs to the spleen, stomach, large intestine, liver and pericardium meridians, purges damp-heat, regulates intestinal conduction, and also helps the normal exertion of the dispersing and discharging functions of the liver and gallbladder.

By comprehensively regulating multiple zang-fu organs and restoring their normal physiological functions, the purpose of treating damp-heat jaundice is achieved, which embodies the holistic concept and syndrome differentiation and treatment thinking of traditional Chinese medicine.

3. Promoting Urination and Defecation, Resolving Damp-Heat Separately

Rhubarb purges the stool, and Gardenia clears and promotes urination. When both defecation and urination are smooth, it provides an outlet for the damp-heat pathogen, eliminating it from both the front and the back. When the stool is unobstructed, it can reduce the retention and absorption of damp-heat in the intestines. When urination is clear, the damp-heat pathogen is excreted from the body through urine.

This treatment method of eliminating damp-heat conforms to the pathological characteristics of damp-heat jaundice, effectively clearing the damp-heat pathogen, preventing it from further accumulating in the body and aggravating the condition, and contributing to the rapid subsidence of jaundice and the recovery of the body.

V. Comparison with Other Similar Formulas

1. Comparison with Zhizi Baipi Decoction

Zhizi Baipi Decoction comes from Treatise on Febrile Diseases and is composed of Gardenia, Licorice Root, and Phellodendron Bark. Both prescriptions have the effect of clearing heat, promoting diuresis, and relieving jaundice.

Compared with Zhizi Baipi Decoction, Yinchenhao Decoction contains Rhubarb, which has a stronger purging effect and can eliminate the damp-heat pathogen from both the stool and urine, and is more focused on treating damp-heat jaundice accompanied by constipation. While Zhizi Baipi Decoction does not contain Rhubarb, with a weaker purging power, it is relatively more focused on clearing heat and is applicable to damp-heat jaundice without constipation.

2. Comparison with Mahuang Lianqiao Chixiaodou Decoction

Mahuang Lianqiao Chixiaodou Decoction also comes from Treatise on Febrile Diseases and is composed of Ephedra, Forsythia, Apricot Kernel, Red Adzuki Bean, Chinese Date, Fresh Catalpa Bark, Ginger, and Licorice Root. This prescription is mainly used to treat jaundice with concurrent exterior syndrome of damp-heat.

Yinchenhao Decoction mainly focuses on clearing heat and promoting diuresis and is applicable to jaundice caused by simple internal accumulation of damp-heat. Based on clearing heat and promoting diuresis, Mahuang Lianqiao Chixiaodou Decoction adds exterior-resolving herbs such as Ephedra and Apricot Kernel and is applicable to damp-heat jaundice with unresolved exterior syndrome, such as symptoms of aversion to cold, fever, and absence of sweating.

3. Comparison with Ganlu Xiaodu Dan

Ganlu Xiaodu Dan It was first recorded in "Warm Disease Classics" written by Wang Shixiong in the Qing Dynasty. It has the effects of promoting diuresis to eliminate dampness and clearing heat and detoxifying. It is mainly used to treat damp-warm epidemic disease, pathogenic factors remaining in the qi aspect, with equal importance of dampness and heat syndrome.

Yinchenhao Decoction is mainly used for damp-heat jaundice, with the main effect of clearing heat and promoting diuresis to remove jaundice. In addition to clearing heat and promoting diuresis, Ganlu Xiaodu Dan focuses more on resolving turbidity and detoxifying, and is applicable to the condition where damp-heat pathogens are diffused, blocking qi movement, accompanied by symptoms such as chest distress, abdominal distension, limb soreness and fatigue due to internal obstruction of damp-turbidity.

VI. Clinical Applications and Indications

1. Jaundice Hepatitis

Yinchenhao Decoction It is a commonly used prescription for treating icteric hepatitis. For icteric hepatitis of damp-heat accumulation type, with symptoms such as yellowing of the body and eyes, bright yellow color, fever with bitter taste in the mouth, nausea and vomiting, yellowish urine, dry stools, etc., Yinchenhao Decoction can effectively clear away damp-heat and remove jaundice, improve liver function and reduce the jaundice index.

Modern medical research shows that the drug components in Yinchenhao Decoction have a protective effect on liver cells, can reduce liver cell inflammation, promote liver cell repair, and thus contribute to the recovery of icteric hepatitis.

2. Cholecystitis with Jaundice

When patients with cholecystitis present jaundice symptoms, if differentiated as damp-heat accumulation syndrome, Yinchenhao Decoction can be used as a treatment prescription. The drugs in the prescription can clear away damp-heat in the liver and gallbladder, relieve cholecystitis symptoms and reduce the degree of jaundice.

Yinchenhao Decoction treats cholecystitis with jaundice by regulating the dispersing and discharging functions of the liver and gallbladder, promoting bile excretion, and reducing gallbladder inflammation. When applied clinically, the drugs are often added or subtracted appropriately according to the condition.

3. Gallstones with Jaundice

When gallstones block the bile duct and cause jaundice due to poor bile excretion, Yinchenhao Decoction can play a role to a certain extent. Its effect of clearing heat and promoting diuresis helps reduce bile duct inflammation, promote bile excretion, and relieve jaundice symptoms.

However, for gallstones with jaundice, Yinchenhao Decoction is usually used as an adjuvant treatment formula and needs to be combined with other treatment methods such as lithotripsy and cholagogic. During the application process, the changes in the condition should be closely observed, and the treatment plan should be adjusted according to the size and location of the stones.

VII. Modified Yinchenhao Decoction

1. Heat Exceeding Dampness

If the heat symptoms are more obvious, the dosage of Gardenia jasminoides Ellis can be increased to enhance the effect of clearing heat and purging fire; or Coptis chinensis Franch. and Phellodendron amurense Rupr. can be added to further clear heat and dry dampness. Coptis chinensis Franch. and Phellodendron amurense Rupr. are strongly bitter and cold in nature, which can enhance the heat-clearing effect of the whole formula and are applicable to cases where heat is more severe than dampness, the jaundice color is deeper, the fever is higher, and the thirst is more severe.

2. Dampness Exceeding Heat

When dampness pathogen is relatively predominant, Poria cocos (Schw.) Wolf and Alisma orientale (Sam.) Juz. can be added to enhance the effect of promoting diuresis. Poria cocos (Schw.) Wolf and Alisma orientale (Sam.) Juz. promote diuresis and percolate dampness, enabling the dampness pathogen to be excreted through urine and relieving symptoms of excessive dampness, such as heaviness of limbs, chest distress and abdominal distension, and difficult urination.

Magnolia officinalis Rehd. et Wils. and Atractylodes lancea (Thunb.) DC. can also be added to dry dampness and promote qi movement, which helps improve the transportation and transformation functions of the spleen and stomach and enhance the dampness-eliminating effect. Magnolia officinalis Rehd. et Wils. and Atractylodes lancea (Thunb.) DC. can dry dampness and strengthen the spleen, eliminating symptoms such as abdominal distension and poor appetite caused by dampness obstruction in the middle jiao.

3. With Hypochondriac Pain

If accompanied by pain in the hypochondrium, herbs for soothing the liver, regulating qi and relieving pain such as Bupleurum chinense DC., Curcuma aromatica Salisb. and Melia toosendan Sieb. et Zucc. can be added. Bupleurum chinense DC., Curcuma aromatica Salisb. and Melia toosendan Sieb. et Zucc. can soothe the liver and relieve depression, promote qi movement and relieve pain, relieve the pain in the hypochondrium caused by liver and gallbladder qi stagnation, and enhance the effect of soothing the liver and promoting bile flow of the whole formula.

4. Loose Stools

If the stool is loose, the dosage of rhubarb should be reduced to prevent excessive purgation from damaging the spleen and stomach. Appropriate herbs for strengthening the spleen such as Chinese yam and atractylodes macrocephala can be added to protect the functions of the spleen and stomach while still maintaining the effect of clearing heat, promoting diuresis and removing jaundice.

VIII. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional Method

Artemisia capillaris 18g, gardenia 9g, rhubarb 6g. Boil these three herbs in 2000 ml of water. First, boil artemisia capillaris until the volume is reduced by 1200 ml, then add the other two herbs and continue boiling until 600 ml remains. Remove the residue and divide the decoction into three equal portions for oral administration.

The traditional method of decocting and taking medicine emphasizes the compatibility and synergistic effects of herbs. Boil artemisia capillaris first because it has a light flavor and can first raise the clear yang. Then add gardenia and rhubarb to achieve the effect of clearing heat, promoting diuresis and removing jaundice. Divide the decoction into three equal portions for oral administration to evenly distribute the medicinal power and continuously exert its effect.

2. Modern Concentrated Granules

The dosage of modern concentrated granules of artemisia capillaris decoction is generally adjusted according to the proportion of the traditional formula. Artemisia capillaris granules 18g, gardenia granules 9g, rhubarb granules 6g.

When taking, dissolve the granules with an appropriate amount of boiling water. Modern concentrated granules are convenient, fast, easy to store and take, suitable for the modern fast-paced lifestyle. However, when using them, it is also necessary to follow the principle of syndrome differentiation and treatment in traditional Chinese medicine and adjust the dosage according to the condition.

IX. Precautions and Taboos

1. Stop when symptoms relieved

Artemisia capillaris decoction is a formula with a bitter and cold nature and has a strong effect of clearing heat and promoting diuresis. It should be stopped once the disease is cured to avoid excessive medication from damaging healthy qi. When the jaundice symptoms are significantly relieved and the signs of damp-heat are alleviated, the treatment plan should be adjusted in time to avoid cold herbs from injuring the yang qi of the spleen and stomach.

2. Use with caution for weak spleen

Those with deficiency-cold of the spleen and stomach, such as those with a weak constitution and poor spleen and stomach function, often having symptoms like abdominal pain, diarrhea, aversion to cold and cold limbs, should not use Yinchenhao Decoction. Because of its bitter and cold nature, it is likely to damage the yang qi of the spleen and stomach and exacerbate the deficiency-cold symptoms.

3. Use with caution during pregnancy

Pregnant women should be cautious about taking medicine. The drug components in Yinchenhao Decoction may have an impact on the fetus. Although there is no clear report on the absolute contraindication of Yinchenhao Decoction for pregnant women, considering its bitter and cold nature with purgative effect, pregnant women should use it with caution under the guidance of a doctor to avoid affecting the health of the fetus.

4. Dietary taboos

During the period of taking Yinchenhao Decoction, spicy, greasy and stimulating foods such as chili peppers and fried foods should be avoided. These foods are likely to generate damp-heat and are not conducive to the recovery of the disease. The diet should be kept light, and eating more vegetables and fruits is helpful for clearing heat and promoting diuresis.

X. Modern Research Progress

1. Research on pharmacological effects

Yinchenhao Decoction originated from Treatise on Febrile Diseases and is a representative prescription for treating damp-heat jaundice, with the effects of clearing heat and promoting diuresis, clearing heat and removing dampness, and reducing jaundice. Patients often present with jaundice, thirst, difficult urination, slight abdominal fullness, and yellow and greasy tongue coating. This prescription uses Artemisia capillaris, Gardenia jasminoides, Rheum officinale, etc. Clinically, it is often compared with Gardenia and Corktree Bark Decoction and is applicable to damp-heat jaundice syndromes such as cholecystitis and leptospirosis, enabling the jaundice to subside spontaneously.

Modern research shows that Artemisia capillaris in Yinchenhao Decoction has the effects of promoting bile secretion, protecting the liver, antibacterial, antiviral, etc. Its effect of promoting bile secretion can promote bile secretion and excretion, reduce the bilirubin content in bile, and relieve jaundice. The effect of protecting the liver can reduce liver cell damage and promote liver cell repair and regeneration.

Gardenia jasminoides has the effects of anti-inflammatory, antibacterial, antipyretic, liver-protecting, etc. Its anti-inflammatory effect can reduce the inflammatory response, and the liver-protecting effect helps to maintain the normal function of liver cells. Rheum officinale has the effects of purgation, antibacterial, anti-inflammatory, anti-tumor, etc. The purgative effect can promote the excretion of intestinal toxins, and the antibacterial and anti-inflammatory effects help to control infections, which has a positive significance for the improvement of the overall condition.

2. Verification of clinical efficacy

A large number of clinical studies have confirmed the effectiveness of Yinchenhao Decoction in the treatment of jaundice-related diseases. In the treatment of icteric hepatitis, cholecystitis with jaundice, cholelithiasis with jaundice and other diseases, Yinchenhao Decoction can effectively improve symptoms, reduce the jaundice index, improve liver function indicators, and shorten the course of disease.

Through the clinical observation of jaundice patients of different ages and different etiologies, it is found that Yinchenhao Decoction has a good therapeutic effect on most patients with accurate syndrome differentiation and high safety.

3. Research on Dosage Form Improvement

With the development of modern pharmaceutical technology, certain progress has been made in the dosage form improvement of Yinchenhao Decoction. In addition to the traditional decoction and modern concentrated granules, dosage forms such as capsules and tablets of Yinchenhao Decoction have also been developed.

These new dosage forms are convenient for taking and preservation, improving the compliance of patients. At the same time, in the process of dosage form improvement, attention is paid to the research of drug quality control and efficacy stability, ensuring that the efficacy of the new dosage form is equivalent to that of the traditional dosage form, providing more choices for the clinical application of Yinchenhao Decoction.