I. Prescription Source & History

1. Recorded in Classic Works

Zhuye Shigao Decoction originated from the classic Chinese medical work Treatise on Febrile Diseases, written by Zhang Zhongjing, the medical sage in the Eastern Han Dynasty. It is recorded in Treatise on Febrile Diseases: Differentiation of Cold Damage, Miscellaneous Diseases of Yin Disorder, Exhaustion after Febrile Diseases, Pulse Syndromes and Their Treatments: "After the resolution of cold damage, if there is weakness, shortness of breath, reversed qi and a tendency to vomit, Zhuye Shigao Decoction is the main treatment." These few words precisely describe the diseases and main symptom manifestations for which Zhuye Shigao Decoction is applicable.

2. Inheritance & Development

Since the publication of Treatise on Febrile Diseases, Zhuye Shigao Decoction has been passed down through generations in clinical Chinese medicine. Later generations of medical practitioners have continuously enriched and improved its application. Not only have they accumulated more experience in treating the late stage of febrile diseases caused by cold damage, but they have also extended its application scope to other similar diseases. With the development of Chinese medical science, the research on Zhuye Shigao Decoction has become increasingly in-depth. From the compatibility principles of the formula to the observation and analysis of clinical efficacy, there has been a more systematic and comprehensive understanding, making it a shining pearl in the treasure house of Chinese medical formulas, relieving the pain of countless patients.

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

1. King Drug - Gypsum

Gypsum is pungent, sweet, and extremely cold in nature, and belongs to the lung and stomach meridians. Its texture is heavy, and its cold nature is strong. It can clear heat and purge fire, and is the main force for clearing heat in the formula. In Zhuye Shigao Decoction, gypsum acts on the residual heat that has not been cleared in the late stage of febrile diseases and the pathogenic heat filling the lung and stomach, playing the role of directly reducing the fire. For symptoms such as high fever, restlessness, and sweating, gypsum can quickly clear the heat in the lung and stomach, enabling the pathogenic heat to be removed and the body fluids to be preserved.

2. Minister Drugs - Lophatherum, Ophiopogon

Bamboo leaf is sweet, pungent, and light in flavor, cold in nature, and belongs to the heart, stomach, and small intestine meridians. It is light and floats upward, capable of clearing heat and relieving restlessness. When combined with gypsum, it enhances the power of clearing heat and relieving restlessness. At the same time, bamboo leaf can also guide the pathogenic heat out through urine, providing a way for the pathogen to exit. Ophiopogon japonicus is sweet, slightly bitter, and slightly cold in nature, and belongs to the heart, lung, and stomach meridians. Ophiopogon japonicus can both nourish the yin of the lung and stomach and clear the heart and relieve restlessness. When combined with the herbs for clearing heat and purging fire such as gypsum, one restrains the fire and the other nourishes yin, jointly achieving the effect of clearing heat and nourishing yin to make up for the deficiency of yin fluid consumed in the late stage of febrile diseases.

3. Assistant Drug - Pinellia

Pinellia ternata is pungent in flavor and warm in nature, and belongs to the spleen, stomach, and lung meridians. Although it is a warm-natured drug in the formula, when combined with a large number of cold-natured herbs for clearing heat, it plays a unique role. On the one hand, Pinellia ternata can harmonize the stomach and descend adverse qi, relieving the symptoms of reversed qi and a tendency to vomit. On the other hand, it can restrict the excessive cold nature of drugs such as gypsum, making the whole formula combine cold and warm properties, with opposite相成, to achieve a better therapeutic effect.

4. Guide Drugs - Ginseng, Licorice, Japonica Rice

Ginseng is sweet, slightly bitter, and slightly warm in nature, greatly tonifying primordial qi, restoring the pulse and securing collapse, tonifying the spleen and benefiting the lung, promoting the production of body fluids and nourishing blood, calming the mind and enhancing intelligence. In the late stage of febrile diseases, when the healthy qi is already deficient, ginseng can benefit qi and strengthen the spleen, strengthening the healthy qi and tonifying deficiency, enabling the healthy qi to be restored and contributing to the recovery of the body. Licorice is sweet in flavor and neutral in nature, and belongs to the heart, lung, spleen, and stomach meridians. Licorice can both invigorate the spleen and replenish qi and harmonize all the drugs in the formula, enabling the drugs in the formula to synergize with each other and exert the best therapeutic effect. Japonica rice is sweet in flavor and neutral in nature, and belongs to the spleen and stomach meridians. It can benefit the spleen and stomach, protect the stomach qi, enable the functions of the spleen and stomach to be restored, and serve as the source for the generation of qi and blood. These three herbs together serve as the adjuvant drugs, playing the role of strengthening the healthy qi and tonifying deficiency, harmonizing the properties of the drugs, and protecting the stomach qi, ensuring that the formula can dispel pathogens without damaging the healthy qi and can better exert its therapeutic effect.

III. Pathogenesis, Efficacy & Indications

1. Pathogenesis Analysis

In the late stage of febrile diseases caused by cold damage, although the pathogenic heat has subsided, the residual heat remains and lingers in the lung and stomach. The lung governs qi and controls respiration, and the stomach is the sea of water and grains, responsible for ripening food. The pathogenic heat accumulates in the lung and stomach, leading to disharmony of the functions of the lung and stomach, presenting symptoms such as reversed qi and a tendency to vomit, weakness, and shortness of breath. At the same time, the febrile disease process consumes the qi and yin of the human body, resulting in deficiency of the healthy qi and insufficiency of yin fluid, thus forming a syndrome of deficiency in the root and excess in the superficiality.

2. Efficacy

Zhuye Shigao Decoction has the effects of clearing heat and promoting the production of body fluids, benefiting qi and regulating the stomach. Through herbs such as gypsum and bamboo leaf for clearing heat and purging fire, it clears the residual heat in the lung and stomach; uses herbs such as Ophiopogon japonicus to nourish yin and promote the production of body fluids, supplementing the consumed yin fluid; and uses ginseng, licorice, and japonica rice to benefit qi and strengthen the spleen, strengthening the healthy qi and tonifying deficiency, so as to clear heat, restore body fluids, and replenish qi, achieving the purpose of regulating the stomach and descending adverse qi, thereby adjusting the functions of the lung and stomach and restoring the balance of yin and yang in the body.

3. Indicated Diseases

It is mainly used to treat typhoid fever, warm diseases, residual heat of summer diseases not cleared, and syndrome of qi and body fluid depletion. Symptoms include fever with sweating, restlessness in the chest and heart, nausea and vomiting due to qi counterflow, dry mouth with a preference for drinking, or weakness and shortness of breath, red tongue with little coating, and thready and rapid pulse. Clinically, whether it is the appearance of the above symptoms in the later stage of exogenous febrile diseases, or qi and yin deficiency with internal disturbance of residual heat caused by various reasons in internal miscellaneous diseases, as long as the pathogenesis is consistent, Zhuye Shigao Decoction can be used for treatment.

IV. Analysis of Zhuye Shigao Decoction

1. Clear Heat & Nourish Yin

Gypsum is extremely cold in nature and clears heat, and bamboo leaf helps it clear heat and relieve vexation. The two clear the heat of the lung and stomach, so that the residual heat can be cleared. Ophiopogon japonicus nourishes yin, moistens the lung and nourishes the stomach. When combined with heat-clearing drugs, it can not only prevent excessive heat-clearing from damaging yin, but also supplement the deficiency of yin fluid, achieving the effect of clearing heat without damaging healthy qi and nourishing yin without retaining pathogenic factors.

2. Tonify Qi & Harmonize Stomach

Ginseng greatly tonifies primordial qi, licorice and rice nourish qi and strengthen the spleen, protecting the stomach qi. Pinellia ternata harmonizes the stomach and suppresses nausea, regulating qi movement. On the one hand, by tonifying qi and strengthening the spleen, it enhances the healthy qi of the body and improves the disease resistance ability; on the other hand, it harmonizes the stomach and suppresses nausea, relieving symptoms such as nausea and vomiting due to qi counterflow, enabling the spleen and stomach functions to recover, regulating qi movement smoothly, and thus promoting the recovery of the body.

3. Drug Compatibility for Synergy

The herbs in the formula are rigorously combined and synergistic. Gypsum Fibrosum and Phyllostachys nigra leaves work together to clear heat, Ophiopogon japonicus and Panax ginseng work together to supplement qi and nourish yin, and Pinellia ternata, Glycyrrhiza glabra, and Japonica rice work together to harmonize the stomach. All the herbs cooperate with each other to jointly exert the effects of clearing heat and promoting fluid production, supplementing qi and harmonizing the stomach, making the therapeutic effect of the formula more comprehensive and effective.

V. Comparison with Other Similar Formulas

1. Comparison with White Tiger Decoction

White Tiger Decoction With gypsum as the monarch drug, combined with anemarrhena asphodeloides, licorice, and rice, its main efficacy is to clear heat and promote fluid production, and it mainly treats the syndrome of excessive heat in Yangming qi aspect, with symptoms such as high fever, flushed face, excessive thirst with great desire to drink, sweating and aversion to heat, forceful and large pulse, etc. Based on the function of clearing heat and promoting fluid production of Baihu Decoction, Zhuye Shigao Decoction adds herbs for supplementing qi and regulating the stomach, and suppressing adverse qi and stopping vomiting. It is applicable to the syndrome of qi and yin injury in the later stage of febrile disease with residual heat not cleared, manifested as fever with sweating, adverse qi and desire to vomit, etc. Baihu Decoction focuses on clearing and purging excessive heat in qi aspect, while Zhuye Shigao Decoction While clearing heat, more attention should be paid to strengthening healthy qi and regulating qi mechanism.

2. Comparison with Ophiopogon Decoction

Mai Men Dong Tang With Ophiopogon japonicus as the monarch drug, combined with Pinellia ternata, Ginseng, Glycyrrhiza glabra, Japonica rice, and Chinese date, it has the effects of nourishing the lung and stomach, and descending adverse qi. It is mainly used to treat the syndrome of yin deficiency of the lung and stomach with upward adverse qi of qi and fire, manifested as coughing and expectorating foamy saliva, shortness of breath, dry throat, red tongue with little coating, thready and rapid pulse, etc. Zhu Ye Shi Gao Tang Both Zhu Ye Shi Gao Tang and Mai Men Dong Tang have the effect of nourishing the yin of the lung and stomach. However, Zhu Ye Shi Gao Tang has a stronger heat-clearing effect, and it also has Pinellia ternata to harmonize the stomach and descend adverse qi, and is applicable to the situation of residual heat of febrile disease not cleared, qi and yin damaged with qi adverse and vomiting; Mai Men Dong Tang focuses more on nourishing the yin of the lung and stomach and descending adverse qi to stop coughing, and is mostly used for the syndrome of yin deficiency of the lung and stomach with adverse qi cough.

VI. Clinical Applications and Indications

1. Respiratory Diseases

In the late stage of diseases such as pneumonia and bronchitis, if there are symptoms of qi and yin deficiency with residual heat not cleared, such as the body heat has subsided, but there are still cough, expectoration not smooth, dry mouth, shortness of breath and weakness, Zhu Ye Shi Gao Tang can be selected for treatment. It can clear heat and resolve phlegm, supplement qi and nourish yin, relieve cough symptoms, and promote the recovery of the body.

2. Digestive Diseases

For diseases such as chronic gastritis and gastric ulcer, if patients show manifestations of qi and yin deficiency with internal accumulation of stomach heat, such as burning sensation, dull pain in the epigastric region, dry mouth and bitter taste, poor appetite, weakness, etc., Zhu Ye Shi Gao Tang can clear stomach heat, benefit stomach qi, improve gastric discomfort symptoms, and promote the repair of gastric mucosa.

3. Recovery Stage of Infectious Diseases

In the recovery period of infectious diseases such as influenza and viral hepatitis, if patients have symptoms of qi and yin damage, such as low fever, fatigue, loss of appetite, dry mouth and throat, the application of Zhu Ye Shi Gao Tang can strengthen healthy qi and eliminate pathogenic factors, help patients recover physical strength as soon as possible, eliminate residual heat, and shorten the course of disease.

VII. Modifications

1. Excessive Lung Heat

If the lung heat is relatively strong and the cough is obvious, Morus alba root bark and Scutellaria baicalensis can be added to enhance the power of clearing heat and relieving cough. Morus alba root bark is sweet in taste, cold in nature, and belongs to the lung meridian, which can purge the lung to relieve asthma and promote diuresis to eliminate edema; Scutellaria baicalensis is bitter in taste, cold in nature, and belongs to the lung, gallbladder, spleen, large intestine, and small intestine meridians, which can clear heat and dry dampness, purge fire and detoxify, stop bleeding, and prevent miscarriage. When combined with the original formula, they can better clear and drain lung heat.

2. Excessive Stomach Heat

For those with excessive stomach heat and obvious stomach pain, Coptis chinensis and Taraxacum mongolicum can be added to clear the stomach and relieve pain. Coptis chinensis is bitter in taste, cold in nature, and belongs to the heart, spleen, stomach, liver, gallbladder, and large intestine meridians. It can clear heat and dry dampness, purge fire and detoxify. Taraxacum mongolicum is sweet and slightly bitter in taste, cold in nature, and belongs to the liver and stomach meridians. It can clear heat and detoxify, disperse swelling and dissipate nodules, promote diuresis and relieve stranguria. This helps to enhance the effect of clearing stomach heat and relieving stomach pain.

3. Severe Qi-Yin Deficiency

For those with more severe qi and yin deficiency, Astragalus membranaceus and Rehmannia glutinosa can be added to strengthen the function of supplementing qi and nourishing yin. Astragalus membranaceus is sweet in taste, slightly warm in nature, and belongs to the spleen and lung meridians. It can boost qi and raise yang, secure the exterior and stop sweating, promote diuresis and alleviate edema, generate fluid and nourish blood, promote qi circulation and relieve pain, expel pus by supporting healthy qi, and promote granulation and muscle growth. Rehmannia glutinosa is sweet and bitter in taste, cold in nature, and belongs to the heart, liver, and kidney meridians. It can clear heat and cool blood, nourish yin and promote fluid production. This makes the power of supplementing qi and nourishing yin stronger and is more conducive to the recovery of the condition.

VIII. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional Method

The traditional usage of Zhuye Shigao Decoction is to decoct each medicinal slice with water. Generally, gypsum is decocted first to fully exert its effect of clearing heat and purging fire, and then other drugs are added and decocted together. The commonly used dosage is: two handfuls of lophatherum (6g), one jin of gypsum (50g), half a sheng of pinellia ternata (15g), one sheng of ophiopogon japonicus (20g), two liang of ginseng (6g), two liang of licorice (6g), and half a sheng of polished round-grained rice (15g). Take one dose daily and warm it and take it in three times.

2. Modern Concentrated Granules

With the development of modern pharmaceutical technology, Zhuye Shigao Decoction also has a corresponding concentrated granule dosage form. Its taking method is more convenient. Generally, according to the dosage specified in the instructions, it can be taken by冲服 with boiling water. On the basis of maintaining the efficacy of the original prescription, modern concentrated granules are easier to store and take, suitable for the modern fast-paced lifestyle, and convenient for patients to choose according to their own conditions.

IX. Precautions and Taboos

1. Dietary Taboos

During the period of taking Zhuye Shigao Decoction, spicy, greasy, and stimulating foods should be avoided to prevent aggravating the gastrointestinal burden and affecting drug absorption and treatment effect. At the same time, smoking and alcohol consumption should be quit to avoid damaging healthy qi and being unfavorable to the recovery of the condition.

2. Physical Constitution Differences

Those with a deficiency-cold constitution should use Zhuye Shigao Decoction with caution. Because drugs such as gypsum and lophatherum in this prescription are relatively strong in cold nature, those with a deficiency-cold constitution may damage yang qi after taking it, leading to aggravation of cold syndromes. The prescription should be reasonably selected under the guidance of a doctor according to individual physical constitution.

3. Special Situations

When pregnant women, lactating women, and children use Zhuye Shigao Decoction, they should be particularly cautious and must be carried out under the guidance of a doctor. Because the physiological states of these populations are special, the dosage and medication time need to be more strictly controlled to ensure medication safety.

X. Modern Research Progress

1. Pharmacological Research

Zhuye Shigao Decoction is a commonly used prescription for treating deficiency of qi and yin in Yangming and injury of qi and fluid in Yangming, and has the functions of clearing deficiency heat and supplementing qi and yin. It is applicable to syndromes such as remaining pathogenic heat not cleared after diseases such as heatstroke, influenza, measles, scarlet fever, etc., fever and vomiting, and unsmooth subsidence of fever. In the prescription, raw gypsum clears heat, lophatherum gracile (Lophatherum), polished round-grained rice, roasted licorice, Codonopsis pilosula, etc. supplement qi and yin, promote fluid production and relieve thirst, and have a good therapeutic effect on the syndrome of injury of qi and yin.

Modern pharmacological studies have shown that Zhuye Shigao Decoction has effects such as antipyretic, anti-inflammatory, and immune regulation. Gypsum can inhibit the body temperature regulation center and reduce the body temperature of febrile animals; bamboo leaves, Ophiopogon japonicus, etc. have anti-inflammatory effects and can reduce the inflammatory response; ginseng, etc. can enhance the body's immunity and improve the body's disease resistance. These studies provide a scientific basis for the clinical application of Zhuye Shigao Decoction.

2. Clinical Research

Clinical studies have further confirmed the effectiveness of Zhuye Shigao Decoction in the treatment of various diseases. For example, in the treatment of the recovery period of pediatric pneumonia, diabetic gastroparesis and other diseases, Zhuye Shigao Decoction has shown good clinical efficacy, can improve the symptoms of patients and improve the quality of life.

3. Dosage Form Improvement Research

With the development of modern technology, the research on the dosage form improvement of Zhuye Shigao Decoction is also continuously deepening. In addition to the concentrated granule dosage form mentioned above, some studies have explored the preparation of new dosage forms such as capsules and tablets to improve the stability of the drug and the convenience of taking, providing more choices for patients.

As a classic prescription in traditional Chinese medicine, Zhuye Shigao Decoction has been passed down for thousands of years and shows unique advantages and values in clinical application. By deeply understanding its origin, composition, efficacy, application, etc., we can better play its therapeutic role and protect the health of patients. At the same time, the continuous progress of modern research also provides a broad prospect for the further development and application of Zhuye Shigao Decoction.