1. Prescription Source & History

1. Recorded in Ancient Books

Fangfeng Tongsheng San was first recorded in Xuanming Lun Fang written by the famous medical expert Liu Wansu in the Jin Dynasty. Liu Wansu, with the courtesy name Shouzhen and the literary name Tongxuan Chushi, was one of the Four Great Medical Masters in the Jin and Yuan Dynasties. He advocated the theory of fire-heat and was good at using cold-natured drugs to treat diseases. As one of his representative works, Fangfeng Tongsheng San embodies his unique medical thoughts and clinical experiences.

In Xuanming Lun Fang, Fangfeng Tongsheng San is listed in the section of treating typhoid fever and is a formula for relieving both exterior and interior syndromes. The original text records elaborate descriptions of the drug composition, efficacy and treatment, and the principle of formulating the formula, laying a solid foundation for later generations of medical practitioners to use this formula.

2. Historical Evolution

Since its appearance in the Jin Dynasty, Fangfeng Tongsheng San has undergone hundreds of years of inheritance and development. Medical practitioners in successive dynasties have continuously verified its efficacy in clinical practice and adjusted and supplemented the formula according to different historical backgrounds and clinical needs.

During the Ming and Qing dynasties, with the rise of the theory of epidemic febrile diseases, when using Fangfeng Tongsheng San, medical practitioners paid more attention to adding or subtracting drugs in combination with the characteristics of epidemic febrile diseases. For example, when treating the initial stage of epidemic febrile diseases with exterior cold and interior heat syndrome, appropriate heat-clearing and detoxifying drugs were added to enhance the power of clearing heat and relieving the exterior of the formula.

In modern times, with the continuous in-depth study of traditional Chinese medicine, new progress has been made in the dosage form and pharmacological research of Fangfeng Tongsheng San. Modern pharmaceutical technologies have made it into various dosage forms, such as pills and granules, which are convenient for patients to take and also provide convenience for further studying its mechanism of action.

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

1. Monarch Drug

The monarch drugs in Fangfeng Tongsheng San are Saposhnikovia divaricata and Schizonepeta tenuifolia.

Ledebouriella seseloides, pungent and sweet in flavor, slightly warm in nature. It belongs to the bladder, liver, and spleen meridians. It has the effects of dispelling wind and relieving exterior syndrome, eliminating dampness and alleviating pain, and stopping convulsions. Its pungent and warm nature can disperse pathogenic wind and relieve exterior syndrome. It is a commonly used herb for treating wind diseases, which can dispel pathogenic wind in the exterior and make the pathogen disperse through sweating. In Saposhnikovia and Mirabilite Powder, Ledebouriella seseloides can not only disperse pathogenic wind in the muscular surface but also restrict the excessive cold nature of many cold herbs in the formula, playing a role in balancing the medicinal properties.

Schizonepeta tenuifolia, pungent in flavor, slightly warm in nature. It belongs to the lung and liver meridians. It has the effects of relieving exterior syndrome and dispelling wind, promoting eruption and resolving carbuncles, and stopping bleeding. Schizonepeta tenuifolia is light and dispersing, good at relieving exterior syndrome and dispelling wind. Its nature is slightly warm and not strong, and the medicinal property is mild. It is the mildest herb among the herbs for dispelling wind-cold. It can assist Ledebouriella seseloides to enhance the power of relieving exterior syndrome, enabling the pathogen in the exterior to be quickly relieved. At the same time, it also has a certain relieving effect on symptoms such as skin itching.

2. Minister Drug

Ephedra sinica, Mentha haplocalyx, Rheum palmatum, and Natrii Sulfas are ministerial herbs.

Ephedra sinica, pungent and slightly bitter in flavor, warm in nature. It belongs to the lung and bladder meridians. It can induce sweating and relieve exterior syndrome, promote the dispersal of lung qi and relieve asthma, and promote diuresis and reduce swelling. Ephedra sinica is pungent, dispersing, bitter, purging, and warm, dredging. It is good at opening the pores of the skin, promoting the eruption of hair follicles, and has a strong sweating power. It is the key herb for pungent-warm exterior-relieving herbs. In the formula, it is combined with Ledebouriella seseloides and Schizonepeta tenuifolia to enhance the effect of inducing sweating and relieving exterior syndrome, enabling the exterior pathogen to be quickly dispelled. At the same time, Ephedra sinica can also promote the dispersal of lung qi and relieve asthma, and has a certain therapeutic effect on asthma and cough caused by the stagnation of lung qi.

Mentha haplocalyx, pungent in flavor, cool in nature. It belongs to the lung and liver meridians. It has the effects of dispersing wind-heat and clearing the head and eyes. Mentha haplocalyx has a fragrant smell, pungent and cool, dispersing. It can disperse wind-heat in the upper jiao, clear the head and eyes, and benefit the throat. Acting synergistically with exterior-relieving herbs such as Ephedra sinica and Ledebouriella seseloides, it can enhance the power of dispersing wind-heat, enabling the wind-heat pathogen to be resolved from the exterior, and can also relieve symptoms such as headache and conjunctival congestion caused by the disturbance of wind-heat in the upper part.

Rheum palmatum, bitter in flavor, cold in nature. It belongs to the spleen, stomach, large intestine, liver, and pericardium meridians. It has the effects of purging and reducing accumulation, clearing heat and purging fire, cooling blood and detoxifying, and removing blood stasis and dredging channels. Rheum palmatum is bitter, cold, descending, and purging. It is good at purging the accumulation of excessive heat in the gastrointestinal tract. It is the key herb for treating constipation due to excessive heat. In Saposhnikovia and Mirabilite Powder, Rheum palmatum is combined with Natrii Sulfas to purge the excess heat in the yangming meridian, enabling the interior heat to be discharged through the stool, so as to achieve the purpose of removing the root cause, and thus relieve many symptoms caused by the exuberance of interior heat.

Natrii Sulfas, salty and bitter in flavor, cold in nature. It belongs to the stomach and large intestine meridians. It can purge and reduce accumulation, moisten dryness and soften hardness, clear heat and reduce swelling. Natrii Sulfas is salty and cold, and its nature descends. It is good at softening hardness and purging, clearing heat and purging fire. Combined with Rheum palmatum, it enhances the purging power, enabling the dry feces to be purged. At the same time, it can also clear heat and purging fire, and has a good therapeutic effect on the syndrome of yangming fu-organ excess, dryness and heat accumulation.

3. Assistant Drug

Gypsum Fibrosum, Scutellaria baicalensis, Forsythia suspensa, Platycodon grandiflorus, Ligusticum chuanxiong, Angelica sinensis, Paeonia lactiflora, Atractylodes macrocephala, Gardenia jasminoides, and Talc are adjuvant herbs.

Gypsum, pungent and sweet in flavor, extremely cold in nature. It pertains to the Lung and Stomach meridians. It has the effects of clearing heat and purging fire, removing vexation and quenching thirst. Gypsum, being extremely cold, can clear the excess heat in the qi aspect of the Lung and Stomach meridians. When combined with exterior-resolving herbs such as Ephedra and Mentha haplocalyx, it can prevent the exterior pathogen from transforming into heat internally. At the same time, it has a good heat-clearing effect on symptoms such as high fever and vexatious thirst caused by intense internal heat.

Scutellaria baicalensis, bitter in flavor, cold in nature. It pertains to the Lung, Gallbladder, Spleen, Large Intestine, and Small Intestine meridians. It can clear heat and dry dampness, purge fire and detoxify, stop bleeding, and prevent miscarriage. Scutellaria baicalensis, being bitter and cold, is good at clearing the fire of the Lung and the excess heat in the upper jiao. Acting synergistically with gypsum, it enhances the power of clearing heat and purging fire, and has a certain therapeutic effect on symptoms such as cough due to Lung heat and sore throat.

Forsythia suspensa, bitter in flavor, slightly cold in nature. It pertains to the Lung, Heart, and Small Intestine meridians. It has the effects of clearing heat and detoxifying, dissipating swelling and nodules, and dispersing wind-heat. Forsythia suspensa is light and floats upward, being good at dispersing wind-heat in the upper jiao and clearing heat and detoxifying. In the formula, it can assist Mentha haplocalyx and Saposhnikovia divaricata in dispersing wind-heat. At the same time, it has the effect of detoxifying and reducing swelling on carbuncles and sores caused by the accumulation of heat-toxin.

Platycodon grandiflorum, bitter and pungent in flavor, neutral in nature. It pertains to the Lung meridian. It can promote the dispersing function of the Lung, resolve phlegm, soothe the throat, and expel pus. Platycodon grandiflorum is pungent and dispersing, bitter and discharging, being good at promoting the dispersing function of the Lung qi, and is an important herb for treating diseases in the qi aspect of the Lung meridian. It can carry the herbs upward, enabling the medicinal power to reach the affected area directly. At the same time, it has a certain regulating effect on symptoms such as cough and unsmooth expectoration caused by the failure of the Lung qi to disperse.

Ligusticum chuanxiong, pungent in flavor, warm in nature. It pertains to the Liver, Gallbladder, and Pericardium meridians. It has the effects of promoting blood circulation and regulating qi, dispelling wind and relieving pain. Ligusticum chuanxiong is pungent, fragrant, and running around, being able to rise to the head, and is an important herb for treating headache. In the Fangfeng Tongsheng Powder, Ligusticum chuanxiong can dispel wind and relieve pain, and has a good therapeutic effect on headache caused by exogenous wind pathogen or wind-heat disturbing the upper part. At the same time, it can regulate qi and promote blood circulation, helping to regulate the syndrome of qi and blood stagnation.

Angelica sinensis, sweet, pungent in flavor, warm in nature. It pertains to the Liver, Heart, and Spleen meridians. It has the functions of enriching blood and promoting blood circulation, regulating menstruation and relieving pain, and moistening the intestines and promoting defecation. Angelica sinensis is sweet, warm, and moist in nature, and is a sacred herb for enriching blood. In the formula, it can both enrich blood to nourish nutrient blood and promote blood circulation to make qi and blood smooth. When combined with Ligusticum chuanxiong, it enhances the power of regulating qi and promoting blood circulation. At the same time, it can relieve symptoms such as sallow complexion and dizziness caused by blood deficiency.

Paeonia lactiflora, bitter and sour in flavor, slightly cold in nature. It pertains to the Liver and Spleen meridians. It has the effects of nourishing blood and regulating menstruation, astringing yin and stopping sweating, soothing the Liver and relieving pain, and suppressing the hyperactive Liver yang. Paeonia lactiflora, being sour and cold, can astringe and collect, nourish blood and astringe yin, soothe the Liver and relieve pain. Acting synergistically with Angelica sinensis, it enhances the power of enriching blood and nourishing the Liver, and has a certain therapeutic effect on symptoms such as hypochondriac pain and irregular menstruation caused by insufficient Liver blood. At the same time, it can restrict the excessive pungent-dispersing property of the herbs in the formula.

Atractylodes macrocephala, bitter and sweet in flavor, warm in nature. It pertains to the Spleen and Stomach meridians. It can strengthen the Spleen and replenish qi, dry dampness and promote diuresis, stop sweating, and prevent miscarriage. Atractylodes macrocephala, being sweet, warm, bitter, and drying, is good at tonifying qi of the Spleen and drying dampness and promoting diuresis. In the formula, it can transform and transport the Spleen and Stomach, enhance the transportation and transformation function of the Spleen and Stomach, enabling qi and blood to be generated from the source. At the same time, it has a certain regulating effect on symptoms such as abdominal distension and diarrhea caused by the obstruction of damp pathogen.

Gardenia jasminoides, bitter in taste and cold in nature. It belongs to the heart, lung, and triple energizer meridians. It can purge fire and remove vexation, clear heat and promote diuresis, cool the blood and detoxify. Gardenia jasminoides is bitter and cold, clearing and descending, capable of purging the fire of the triple energizer and conducting heat downward. When combined with heat-clearing herbs such as Scutellaria baicalensis and Gypsum Fibrosum, it enhances the power of clearing heat and purging fire, and has a good therapeutic effect on symptoms such as vexation, bitter taste in the mouth, and red urine caused by excessive heat in the triple energizer.

Talcum, sweet and bland in taste and cold in nature. It belongs to the bladder, lung, and stomach meridians. It has the effects of inducing diuresis for treating stranguria, clearing heat and relieving summer heat, and astringing dampness and promoting granulation. Talcum is heavy in texture and cold in nature, capable of clearing heat and promoting diuresis, causing pathogenic damp-heat to be excreted through urine. When combined with laxatives such as Rheum palmatum and Natrii Sulfas, it enhances the effects of clearing heat, purging downward, and promoting diuresis, and at the same time has a certain therapeutic effect on symptoms such as short and red urine, and painful and hesitant urination caused by downward flow of damp-heat.

4. Guide Drug

Licorice root is used as an envoy drug.

Licorice root, sweet in taste and neutral in nature. It belongs to the heart, lung, spleen, and stomach meridians. It can invigorate the spleen and replenish qi, moisten the lungs and relieve cough, clear heat and detoxify, and harmonize all the drugs in a prescription. Licorice root in the prescription can not only harmonize all the drugs, enabling various drugs to cooperate with each other and exert the best therapeutic effect, but also invigorate the spleen and replenish qi, protect the spleen and stomach, and prevent the drastic drugs from damaging the healthy qi of the spleen and stomach. Its sweet and slow nature can also relieve the properties of the drugs in the prescription, making the nature of the whole prescription mild and easy to take.

III. Pathogenesis, Effects and Indications

1. Pathogenesis

The pathogenesis targeted by Ledebouriella-Siler diffusa Powder is mainly exogenous wind pathogen, internal accumulation of heat, and excessiveness of both exterior and interior.

When exogenous wind pathogen invades the muscle surface, the defensive qi is stagnated, and the opening and closing functions are disordered, symptoms of exterior syndrome such as fever, aversion to cold, headache, and body pain may occur. At the same time, wind pathogen is likely to be accompanied by cold, heat, dampness and other pathogenic factors. If accompanied by heat pathogen, symptoms such as sore throat and red eyes may occur; if accompanied by damp pathogen, symptoms such as heaviness of limbs and chest distress may occur.

Internal accumulation of heat is mostly due to improper diet in daily life, overeating spicy, fatty, sweet and rich foods, resulting in abnormal transportation and transformation of the spleen and stomach, and endogenous accumulation of heat. When heat pathogen accumulates in the interior, symptoms such as bitter taste in the mouth, dry throat, dry and hard stools, and short and red urine may occur. When the exterior pathogen is not resolved and the interior heat is intense, with the combination of exogenous and endogenous pathogens, the syndrome of excessiveness of both exterior and interior is formed.

2. Effects

Fangfeng Tongsheng San has the effects of relieving exterior syndrome and purging interior, inducing sweating to reach the exterior, and dispersing wind and clearing heat.

Through the actions of exterior-relieving herbs such as Ephedra, Ledebouriella seseloides, Schizonepeta tenuifolia, and Mentha haplocalyx, it induces sweating to relieve the exterior syndrome, disperses the wind pathogen in the exterior, and enables the rapid relief of exterior pathogens. At the same time, purgative herbs such as Rheum palmatum and Natrii Sulfas are combined with heat-clearing herbs such as Gypsum Fibrosum, Scutellaria baicalensis, and Forsythia suspensa to purge accumulation and clear heat and fire, allowing the interior heat to exit through the stool, achieving the purpose of removing the root cause. In addition, the synergistic action of many herbs in the formula can also disperse wind and relieve heat, alleviating various symptoms caused by the upward disturbance of wind-heat.

3. Indications

Fangfeng Tongsheng San is mainly used for the syndrome of wind-heat exuberance and excess syndrome of both exterior and interior.

The clinical manifestations include aversion to cold and high fever, dizziness of the head and eyes, red and painful eyes, bitter taste in the mouth and dry mouth, discomfort in the throat, stuffiness and fullness in the chest and diaphragm, coughing, vomiting, wheezing and fullness, thick and sticky nasal discharge and saliva, constipation, red and astringent urine. And also carbuncles, sores, rubella, eczema, purplish macules and hidden rashes, etc. Aversion to cold and high fever means the simultaneous presence of aversion to cold and fever, and the aversion to cold is severe and the fever is also severe, which is one of the typical manifestations of excess syndrome of both exterior and interior. Symptoms such as dizziness of the head and eyes, red and painful eyes are caused by the upward disturbance of wind-heat in the clear orifices. Bitter taste in the mouth and dry mouth, discomfort in the throat, etc. are manifestations of excessive interior heat. Symptoms such as stuffiness and fullness in the chest and diaphragm, coughing, vomiting, wheezing and fullness are related to the stagnation of lung qi and the accumulation of phlegm-heat. Constipation and red and astringent urine are manifestations of the impairment of body fluid by interior heat and the abnormal conduction of the intestines and bladder. Skin diseases such as carbuncles, sores, rubella, eczema are mostly caused by the accumulation of wind-heat, dampness and toxin in the muscles and skin. Fangfeng Tongsheng San can disperse the heat-toxin pathogen through relieving the exterior and clearing the interior, thus alleviating these diseases.

IV. Analysis of Formula Principles

1. Combining Exterior-Releasing and Interior-Purging

In Fangfeng Tongsheng San, exterior-relieving herbs and interior-purging herbs are used together, embodying the treatment method of relieving both exterior and interior. Exterior-relieving herbs such as Ephedra, Ledebouriella seseloides, Schizonepeta tenuifolia, and Mentha haplocalyx can quickly disperse the wind pathogen in the muscle surface, allowing the pathogen to have an outlet. And interior-purging herbs such as Rheum palmatum and Natrii Sulfas can purge the excess heat in the Yangming meridian, eliminate the accumulation in the gastrointestinal tract, and enable the interior heat to exit through the stool. This method of using exterior-relieving and interior-purging herbs together can not only relieve the exterior pathogen but also clear the interior heat, prevent the exterior pathogen from transforming into heat inside, prevent the interior heat from becoming excessive and aggravating the disease condition, and enable the exterior and interior pathogens to be relieved simultaneously, achieving the purpose of treating both the symptoms and the root cause.

2. Synergistic clearing heat and purging fire

In the formula, heat-clearing and fire-purging herbs such as Gypsum Fibrosum, Scutellaria baicalensis, Forsythia suspensa, and Gardenia jasminoides work synergistically to clear the excess heat in the lung, stomach, triple energizer and other zang-fu organs. Gypsum Fibrosum clears the excess heat in the qi aspect of the lung and stomach meridians, Scutellaria baicalensis is good at clearing the lung fire and excess heat in the upper jiao, Forsythia suspensa disperses the wind-heat in the upper jiao and clears heat and detoxifies, Gardenia jasminoides clears the fire of the triple energizer. The combined action of these herbs can effectively remove the accumulated heat pathogen in the body, alleviate various symptoms caused by the heat pathogen, such as high fever, restlessness and thirst, sore throat, red eyes, etc., so that the heat pathogen is cleared and the functions of the zang-fu organs return to normal.

3. Harmonizing Qi and Blood, Spleen and Stomach

Blood-nourishing and blood-activating herbs such as Angelica sinensis, Paeonia lactiflora, and Ligusticum chuanxiong are combined with spleen-strengthening and stomach-regulating herbs such as Atractylodes macrocephala and Glycyrrhiza uralensis to play the role of regulating qi and blood and the spleen and stomach. Angelica sinensis and Paeonia lactiflora nourish blood, Ligusticum chuanxiong promotes blood circulation and regulates qi. The three work together to regulate qi and blood, making qi and blood smooth and nourishing the zang-fu organs. Atractylodes macrocephala strengthens the spleen and replenishes qi, dries dampness and promotes diuresis, Glycyrrhiza uralensis replenishes qi of the spleen, harmonizes various herbs, and at the same time protects the spleen and stomach. The spleen and stomach are the foundation of acquired constitution and the source of qi and blood production. When the functions of the spleen and stomach are normal, qi and blood are sufficient, and the vital qi is strong, which helps to resist external pathogens and promote the recovery of the disease. Moreover, regulating qi and blood and the spleen and stomach can also alleviate various discomfort symptoms caused by qi and blood stagnation and spleen and stomach disharmony, such as pain in the hypochondrium, abdominal distension, diarrhea, etc.

4. Synergistic Effect of Drug Compatibility

Fangfeng Tongsheng San The compatibility of various drugs in it is ingenious and synergistic with each other. For example, the compatibility of Ephedra and Gypsum Fibrosum. Ephedra is pungent and warm for relieving exterior syndrome, and Gypsum Fibrosum is extremely cold for clearing heat. One is warm and the other is cold, being opposite yet complementary. It can not only enhance the power of inducing sweating and relieving exterior syndrome, but also prevent Ephedra from being too pungent and warm to assist heat and generate fire, and prevent Gypsum Fibrosum from being too cold to congeal pathogen qi, making the power of relieving exterior syndrome and clearing heat complement each other. The combination of Rheum officinale and Natrii Sulfas enhances the power of purging and attacking accumulation, enabling the rapid clearance of excessive heat in Yangming meridian. Schizonepeta tenuifolia and Saposhnikovia divaricata are used in combination as mutual reinforcement, enhancing the effect of dispelling wind and relieving exterior syndrome, leaving no place for pathogenic wind in the exterior. The reasonable compatibility of these drugs makes the efficacy of the whole formula more comprehensive and powerful, and can better deal with complex diseases.

V. Comparison with Other Similar Prescriptions

1. Comparison with Yinqiao Powder

Yinqiao San It comes from 'Treatise on Febrile Diseases' written by Wu Jutong in the Qing Dynasty and is a commonly used formula for treating the initial stage of febrile diseases. Compared with Fangfeng Tongsheng San, both have the effect of dispersing wind-heat.

Yinqiao San is mainly aimed at the syndrome of pathogenic factors staying in the lung and defensive qi in the initial stage of febrile diseases. Its drug composition uses Flos Lonicerae Japonicae and Fructus Forsythiae as the monarch drugs, with a relatively strong ability to clear heat and detoxify. It is combined with pungent-cool exterior-relieving drugs such as Herba Schizonepetae, Semen Sojae Praeparatum, Fructus Arctii, and Mentha haplocalyx, which are slightly cool and clear, dispersing wind-heat. The whole formula focuses on clearing heat pathogens in the lung and defensive qi, and the power of relieving exterior syndrome is relatively weak. It is applicable to diseases with relatively mild wind-heat pathogens, mainly manifested by symptoms such as fever, slightly aversion to wind-cold, and sore throat.

Fangfeng Tongsheng San mainly treats the syndrome of excessive wind-heat and excess syndrome in both the exterior and interior. It has more types of exterior-relieving drugs, and the synergistic effect of Ephedra, Saposhnikovia divaricata, Schizonepeta tenuifolia, Mentha haplocalyx, etc. makes the power of relieving exterior syndrome stronger. At the same time, it is combined with a large number of drugs for clearing heat and purging fire, purging and attacking accumulation, which can clear interior heat and purge the accumulation of excessive heat in the stomach and intestines. It is applicable to the situation where heat pathogens in both the exterior and interior are excessive, with relatively complex symptoms, including exterior syndromes such as aversion to cold and fever, headache and body pain, and interior syndromes such as bitter taste in the mouth, dryness in the throat, and constipation.

2. Comparison with Dachaihu Decoction

Major Bupleurum Decoction It is from Treatise on Febrile Diseases and has the effects of reconciling Shaoyang and purging heat accumulation internally. Compared with Saposhnikovia and Lonicera Powder for Purgation, both have the effect of relieving exterior and interior syndromes simultaneously.

Major Bupleurum Decoction is mainly used to treat the combined syndrome of Shaoyang and Yangming, manifested by alternating chills and fever, fullness and discomfort in the chest and hypochondrium, incessant vomiting, mild vexation and depression, firmness and fullness or pain in the epigastrium, constipation or diarrhea associated with heat. In this formula, Bupleurum and Scutellaria are used to reconcile Shaoyang, Rhubarb and Immature Bitter Orange are used to purge heat accumulation internally, Paeony is used to relieve spasm and pain, and Pinellia is used to harmonize the stomach and suppress adverse qi. Major Bupleurum Decoction focuses on reconciling Shaoyang and purging excessive heat in Yangming, mainly targeting the syndrome of disharmony of qi in Shaoyang and Yangming meridians and heat accumulation in the interior.

Although Saposhnikovia and Lonicera Powder for Purgation also has the effect of relieving exterior and purging interior, it emphasizes more on dispersing wind-heat, clearing heat in the lung, stomach and triple energizer, and regulating qi and blood as well as the spleen and stomach. Its scope of treating diseases is wider. In addition to symptoms such as fever and constipation due to both exterior and interior excess, it can also be used to treat various skin diseases caused by the accumulation of wind-heat, dampness and toxin, such as sores, carbuncles, rubella and eczema.

3. Comparison with Shuangjie Tongsheng Powder

Double-acting Purging Powder for Removing Pathogens from Both Exterior and Interior is also a formula for relieving exterior and interior syndromes simultaneously and has similarities with Saposhnikovia and Lonicera Powder for Purgation.

Double-acting Purging Powder for Removing Pathogens from Both Exterior and Interior has a certain relationship with Saposhnikovia and Lonicera Powder for Purgation in terms of drug composition, but there are differences in the dosage and compatibility of some drugs. It also has the effect of relieving exterior and clearing interior, and is used to treat the syndrome of exogenous wind pathogen and internal heat accumulation. However, Saposhnikovia and Lonicera Powder for Purgation is more widely used, and its drug compatibility is more exquisite, being able to better deal with various complex syndromes of both exterior and interior excess. The synergistic effect of various drugs in Saposhnikovia and Lonicera Powder for Purgation has unique advantages in relieving exterior, clearing heat, purging and regulating qi and blood, while Double-acting Purging Powder for Removing Pathogens from Both Exterior and Interior may be relatively inferior in some aspects. For example, the compatibility of heat-clearing drugs such as Gypsum Fibrosum and Scutellaria in Saposhnikovia and Lonicera Powder for Purgation can more effectively clear excessive heat in the lung and stomach, and has a more obvious effect on relieving symptoms such as high fever and thirst.

VI. Clinical Applications and Indications

1. Dermatological Diseases

Saposhnikovia and Lonicera Powder for Purgation It is widely used in dermatology and is often used to treat various skin diseases.

For acne, it is mostly caused by excessive heat in the lung and stomach and exogenous wind pathogen. Saposhnikovia and Lonicera Powder for Purgation can regulate endocrine, improve skin oil secretion and reduce the occurrence of acne by relieving exterior and clearing interior, dispersing wind-heat and clearing heat in the lung and stomach. For those with acne accompanied by symptoms such as swelling, pain, dry and hard stools, bitter taste in the mouth and dry mouth, using Saposhnikovia and Lonicera Powder for Purgation often can achieve good curative effects.

Fangfeng Tongsheng San can also be applied to allergic skin diseases such as rubella and eczema. These diseases are mostly caused by the accumulation of wind-heat, dampness and toxin in the skin. Fangfeng Tongsheng San can disperse wind and clear heat, promote diuresis and detoxify, and relieve symptoms such as skin itching, erythema, and papules. Clinical studies have shown that the combination of Fangfeng Tongsheng San and western anti-allergy drugs in the treatment of allergic skin diseases can improve the curative effect, shorten the course of disease, and reduce the recurrence rate.

2. Respiratory Diseases

In terms of respiratory diseases, Fangfeng Tongsheng San can be used to treat upper respiratory tract infections, tonsillitis, etc.

Upper respiratory tract infections are mostly caused by exogenous wind pathogens and internal accumulation of heat, presenting symptoms such as fever, aversion to cold, headache, and sore throat. Fangfeng Tongsheng San relieves the exterior and clears heat, and can quickly relieve exterior symptoms such as fever and aversion to cold. Clearing interior heat can reduce symptoms such as sore throat and promote the recovery of the disease. For tonsillitis, Fangfeng Tongsheng San can clear heat and detoxify, reduce swelling and relieve sore throat, and improve symptoms such as swelling and pain of the tonsils, especially applicable to patients with interior heat symptoms such as constipation, bitter taste in the mouth and dry throat.

3. Digestive System Diseases

Fangfeng Tongsheng San also has a certain therapeutic effect on digestive system diseases.

For constipation, especially excess-heat constipation, Fangfeng Tongsheng San purges accumulation by using laxatives such as rhubarb and mirabilite, clears the excess-heat accumulation in the intestines, and makes the defecation unobstructed. At the same time, other drugs in the formula act synergistically to regulate gastrointestinal function and improve symptoms such as abdominal distension and bad breath caused by constipation.

In the treatment of dyspepsia, Fangfeng Tongsheng San can regulate the spleen and stomach and promote digestion. For symptoms such as fullness in the epigastrium and loss of appetite caused by food stagnation and abnormal transportation and transformation of the spleen and stomach, Fangfeng Tongsheng San can improve digestive function and relieve discomfort symptoms by strengthening the spleen and stomach and promoting digestion and removing stagnation.

4. Other Conditions (Stroke & Obesity)

Fangfeng Tongsheng San can also be used to treat some other diseases.

Such as hypertension. If patients are accompanied by symptoms such as headache, dizziness, bitter taste in the mouth, dry throat, and dry stools, it is mostly caused by hyperactivity of liver yang and accompanied by wind-heat. Fangfeng Tongsheng San can suppress liver yang, disperse wind-heat, and clear interior heat, which is helpful for improving hypertension symptoms.

For obesity, in some patients, due to improper diet, the transportation and transformation functions of the spleen and stomach are abnormal, phlegm-dampness is internally generated, and wind-heat is combined. Fangfeng Tongsheng San can play an auxiliary role in the treatment of obesity by regulating the functions of the spleen and stomach, resolving phlegm and removing dampness, dispersing wind-heat, and promoting metabolism.

VII. Modified Fangfeng Tongsheng San

1. More Severe Wind-Heat

If wind-heat is relatively severe, the dosages of drugs such as Mentha haplocalyx, Forsythia suspensa, and Scutellaria baicalensis can be increased. Mentha haplocalyx can enhance the power of dispersing wind-heat. Forsythia suspensa clears heat and detoxifies, and has a stronger effect on dispersing wind-heat in the upper jiao. Scutellaria baicalensis can further clear the lung fire and excess heat in the upper jiao, enabling the pathogenic factor of wind-heat to be better cleared.

2. Flourishing Interior Heat

When the interior heat is intense, the dosages of Gypsum fibrosum, Rheum palmatum, and Natrii Sulfas can be increased. The effect of Gypsum fibrosum in clearing the excess heat in the lung and stomach is enhanced. Rheum palmatum and Natrii Sulfas have a stronger purgative effect, can quickly remove the accumulated interior heat, and relieve symptoms such as high fever and dry stools.

3. Severe Dampness

If the pathogenic factor of dampness is relatively severe, drugs for promoting diuresis and removing dampness such as Coix lacryma-jobi, Poria cocos, and Alisma orientale can be added. Coix lacryma-jobi can promote diuresis and remove dampness, strengthen the spleen and stop diarrhea. Poria cocos and Alisma orientale have a significant effect on promoting diuresis and removing dampness, enabling the pathogenic factor of dampness to be excreted through urine, and relieving symptoms such as heaviness of limbs and chest distress caused by internal obstruction of dampness pathogen.

4. Blood Stasis

When symptoms of qi and blood stasis appear, such as pain in the hypochondrium and irregular menstruation, drugs for promoting blood circulation and removing stasis such as Prunus persica, Carthamus tinctorius, and Salvia miltiorrhiza can be added. Prunus persica and Carthamus tinctorius have a strong effect on promoting blood circulation and removing stasis. Salvia miltiorrhiza can not only promote blood circulation and remove stasis, but also nourish blood and soothe the nerves, can improve the situation of qi and blood stasis, and relieve related symptoms.

5. Weak Spleen & Stomach

For those with weak spleen and stomach, the dosages of purgative drugs such as Rheum palmatum and Natrii Sulfas can be reduced, and drugs for strengthening the spleen and replenishing qi such as Codonopsis pilosula and Astragalus membranaceus can be added. Codonopsis pilosula and Astragalus membranaceus can strengthen the spleen and replenish qi, enhance the functions of the spleen and stomach, prevent purgative drugs from damaging the healthy qi of the spleen and stomach, and make the formula more suitable for patients with weak spleen and stomach.

VIII. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional Method

The traditional usage of Fangfeng Tongsheng San is to take it as a decoction. The general dosage is 15 grams each of Saposhnikovia divaricata, Schizonepeta tenuifolia, Forsythia suspensa, Ephedra sinica, Mentha haplocalyx, Ligusticum chuanxiong, Angelica sinensis, Paeonia lactiflora, Atractylodes macrocephala, Gardenia jasminoides, and Rheum palmatum, 30 grams each of Gypsum fibrosum, Scutellaria baicalensis, and Platycodon grandiflorum, 90 grams of Talc, 60 grams of Glycyrrhiza uralensis, and 30 grams of Natrii Sulfas.

Decoct the above-mentioned herbs together by adding water, and take the decoction warm in several times. When taking it, pay attention to the heat intensity and time. Generally, first bring the water to a boil with strong fire, and then change to slow fire for slow decoction to fully dissolve the active ingredients of the herbs. Traditional decoctions can better exert the synergistic effect of the herbs, but taking them is more troublesome and requires patients to decoct by themselves.

2. Modern Concentrated Granules

With the development of modern pharmaceutical technology, there is also a concentrated granule dosage form of Fangfeng Tongsheng Powder. Modern concentrated granules are granule preparations made from traditional Chinese herbs through processes such as extraction and concentration. They are convenient to take and easy to store.

Its dosage is generally determined according to the product specifications of different manufacturers. The common dosage is to make granules of each herb according to a certain proportion, and take a certain dose each time, usually 1 - 2 bags, which can be taken by冲服 with boiling water. Modern concentrated granules maintain the efficacy of traditional prescriptions, and are simple to take, suitable for the modern fast-paced lifestyle, but may be different from traditional decoctions in terms of taste, etc.

IX. Precautions and Taboos

1. Use with Caution for the Weak

The properties of Fangfeng Tongsheng Powder are relatively drastic. For those with weak constitutions, especially those with qi and blood deficiency and spleen and stomach deficiency-cold, taking it may further damage the healthy qi and cause physical discomfort, such as dizziness, fatigue, discomfort in the胃脘, etc. Therefore, if such people need to use it, they should adjust the dosage of the herbs appropriately or combine with other herbs for strengthening healthy qi under the guidance of a doctor according to the specific situation.

2. Prohibited for Pregnant Women

The formula contains Rhubarb for drastic purgation and Mirabilite for softening hardness and purging. These herbs may have adverse effects on the fetus, leading to fetal movement restlessness or even miscarriage. Therefore, pregnant women should strictly prohibit using Fangfeng Tongsheng Powder.

3. Dietary Taboos

During the period of taking Fangfeng Tongsheng Powder, spicy, greasy and stimulating foods should be avoided. These foods are likely to generate heat and promote the fire, aggravating the internal heat accumulation in the body and affecting the curative effect of the herbs. At the same time, smoking and alcohol should be quit, and a light diet should be maintained, which helps the herbs to better exert their effects and promote the recovery of the disease.

4. Do not Take for Long

After all, Fangfeng Tongsheng Powder is a formula for attacking pathogens, and it is not suitable for long-term continuous use. Long-term use may damage the healthy qi, leading to a decline in the body's resistance, and may also cause adverse reactions such as gastrointestinal dysfunction. Generally, after the symptoms are relieved, the medicine should be stopped in time and the treatment plan should be adjusted according to the condition.

10. Research Progress of Fangfengtongsheng Pills

1. Pharmacological Action Research

Fangfeng Tongsheng Powder (Fangfeng Tongsheng Pills) is a representative formula for treating syndromes of excessive pathogenic factors both on the exterior and interior. It has the functions of dispersing wind and relieving exterior syndrome, clearing heat and purging fire, purging heat and promoting defecation, relieving exterior syndrome and dredging the interior. It is applicable to headache, constipation, hard stools, short and red urine caused by exogenous wind-heat or exogenous wind pathogen associated with internal accumulated heat, as well as heat excess syndromes such as sores and ulcers, abdominal abscess, bacillary dysentery, strangury, urticaria, mastitis, etc. Clinically, it is also widely used in obesity, hyperlipidemia, hypertension, fatty liver, facial butterfly spots, etc. In the formula, drugs such as Saposhnikovia divaricata, Schizonepeta tenuifolia, Ephedra sinica, Gypsum fibrosum, Forsythia suspensa, Gardenia jasminoides are combined. The pills are taken orally with warm boiled water, and have good curative effects on the excess heat syndrome with imbalance of yin and yang.

Modern pharmacological studies have shown that Fangfeng Tongsheng Powder has various pharmacological effects. In terms of anti-inflammation, multiple drugs in the formula act synergistically to inhibit the release of inflammatory mediators and reduce the inflammatory response. For example, Scutellaria baicalensis and Forsythia suspensa have anti-inflammatory activities and can relieve inflammatory symptoms such as local redness, swelling, heat and pain.

The immunomodulatory effect is also relatively significant. Fangfeng Tongsheng Powder can regulate the immune function of the body, enhance the resistance of the body, and has a certain regulatory effect on both low or high immune function, helping to maintain the immune balance of the body.

In addition, Fangfeng Tongsheng Powder also has antibacterial and antiviral effects. Drugs such as Rheum palmatum and Scutellaria baicalensis have inhibitory effects on various bacteria and viruses, and can prevent and treat infectious diseases.

2. Clinical Efficacy Observation

A large number of clinical studies have confirmed the effectiveness of Fangfeng Tongsheng Powder in the treatment of various diseases. Fangfeng Tongsheng Powder also has the effect of purging heat and promoting defecation, and is clinically often used to treat obesity and obese patients. It also has curative effects on syndromes such as tracheitis, pneumonia, allergic purpura, flat wart, acute suppurative otitis media, etc. In the formula, drugs such as Zingiber officinale are combined. The pills are mostly made into water pills and should be used with caution in cold syndromes, reflecting the dialectical thinking of strengthening the spleen and drying dampness and syndromes such as stroke.

In the treatment of acne, multiple studies have shown that the combination of Fangfeng Tongsheng Powder and topical drugs in the treatment of moderate to severe acne can significantly improve acne symptoms, reduce the number of Propionibacterium acnes, and reduce the recurrence rate. For allergic skin diseases, the combination of Fangfeng Tongsheng Powder and western medicine can improve the clinical curative effect, shorten the course of disease, reduce symptoms such as pruritus and erythema of patients, and improve the quality of life of patients.

In the treatment of upper respiratory tract infection, constipation and other diseases, Fangfeng Tongsheng Powder also shows good clinical effects, can effectively relieve symptoms and promote the recovery of the disease.

3. Dosage Form Improvement Research

In order to improve the convenience and stability of taking Saposhnikovia and Mirabilite Powder, a large number of studies have been conducted on its dosage form improvement in modern times.

In addition to the concentrated granule dosage form mentioned above, some people have also studied making it into pills, capsules, etc. Pills are convenient for storage and carrying, and capsules are convenient to take and can better mask the unpleasant smell of the drug. These new dosage forms have improved patient compliance on the basis of maintaining the original efficacy of the prescription, providing more choices for clinical application.

4. Discussion on Action Mechanism

With the in-depth study, the mechanism of action of Saposhnikovia and Mirabilite Powder has also been explored more deeply.

Studies have found that Saposhnikovia and Mirabilite Powder may play a role by regulating the neuroendocrine immune network in the body. It can affect the neuroendocrine system such as the hypothalamus-pituitary-adrenal axis, regulating the body's stress response and immune function. At the same time, it can also improve the local and systemic pathophysiological states by regulating cytokines, inflammatory mediators, etc., so as to achieve the purpose of treating diseases.

In short, as a classic traditional Chinese medicine prescription, Saposhnikovia and Mirabilite Powder has shown unique advantages in clinical application after thousands of years of inheritance. Its rich pharmacological effects and extensive clinical indications provide useful references for modern medicine to treat various diseases. With the continuous in-depth modern research, Saposhnikovia and Mirabilite Powder will surely play a greater role in the field of traditional Chinese medicine and make more contributions to human health.