1. Ma Xing Shi Gan Tang Prescription Source & History

1. Recorded in Classic Works

Maxing Shigan Decoction originated from Treatise on Febrile Diseases written by Zhang Zhongjing, a famous medical scientist in the late Eastern Han Dynasty. Treatise on Febrile Diseases is a classic among the classics of traditional Chinese medicine. It systematically expounds the rules of syndrome differentiation and treatment of exogenous febrile diseases, laying a solid foundation for the clinical practice of traditional Chinese medicine in later generations. As one of the important prescriptions in it, Maxing Shigan Decoction has been passed down for thousands of years and is still widely used in clinical practice today.

In Treatise on Febrile Diseases, the clause about Maxing Shigan Decoction is: "After sweating, it is not advisable to use Cinnamon Twig Decoction again. If there is sweating and wheezing, and no high fever, Mahuang Xingren Gancao Shigao Decoction can be used." These few words accurately describe the applicable symptoms and the timing of using this prescription. After sweating, the body fluid is damaged, and at this time, it is not suitable to use Cinnamon Twig Decoction again; if there is sweating and wheezing, and no high fever on the body surface, Maxing Shigan Decoction can be selected for treatment.

2. Historical Evolution & Inheritance

Since the publication of Treatise on Febrile Diseases, Maxing Shigan Decoction has always been valued and applied by medical doctors of past dynasties. As time goes by, its scope of application has been continuously expanded and is not limited to treating exogenous febrile diseases. In clinical practice, medical doctors of later generations have continuously summarized experience and further developed and improved Maxing Shigan Decoction.

For example, during the Jin and Yuan dynasties, medical doctors had new breakthroughs in the understanding and application of Maxing Shigan Decoction. Liu Wansu emphasized the theory of pathogenic fire in his works and believed that Maxing Shigan Decoction could be used to treat various diseases caused by excessive heat in the lung, which provided a deeper theoretical basis for the application of Maxing Shigan Decoction in treating lung heat-related diseases. During the Ming and Qing dynasties, on the basis of inheriting the experience of predecessors, medical doctors conducted more detailed research on the drug compatibility and dosage adjustment of Maxing Shigan Decoction, making this prescription more flexible and changeable in clinical application and with more significant curative effects.

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

1. Ephedra

Mahuang is the sovereign drug in Maxing Shigan Decoction. It tastes pungent and slightly bitter, is warm in nature, and belongs to the lung and bladder meridians. Mahuang has the effects of inducing sweating and relieving exterior syndrome, and dispersing the lung qi to relieve asthma. In the prescription, Mahuang can disperse and ventilate the lung qi, so that the lung qi can be ventilated, thereby relieving the asthma symptoms. It can also relieve the pathogenic factors on the exterior through sweating. Mahuang has a strong sweating power and can quickly open the pores of the human body's skin and muscles, allowing the pathogenic factors to be resolved with sweat. For symptoms such as fever, aversion to cold, absence of sweating, and asthma caused by exogenous wind-cold and stagnation of lung qi, Mahuang plays a key therapeutic role.

However, the use of Mahuang also needs to be cautious. Due to its strong sweating effect, excessive use may lead to excessive sweating and damage the body fluid. Therefore, in clinical application, it is necessary to strictly control the dosage of Mahuang and make reasonable preparations according to the specific conditions of the patients.

2. Apricot Seed

Xingren is the ministerial drug. It tastes bitter, is slightly warm in nature, has a small toxicity, and belongs to the lung and large intestine meridians. Xingren has the functions of lowering qi to relieve cough and asthma, and moistening the intestines to promote defecation. In Maxing Shigan Decoction, Xingren mainly assists Mahuang to enhance the efficacy of relieving asthma and cough. It can lower the lung qi, make the lung qi descend, and together with Mahuang, one dispersing and one descending, jointly regulate the qi movement of the lung, so as to achieve the purpose of relieving cough and asthma. For symptoms such as cough and asthma caused by the adverse rising of lung qi, Xingren plays an important synergistic therapeutic role.

In addition, the function of Xingren in moistening the intestines to promote defecation also helps to relieve the overall condition to a certain extent. Because the lung and the large intestine are interior-exteriorly related, the stagnation of lung qi may affect the conduction function of the large intestine, resulting in constipation and other conditions. By moistening the intestines and promoting defecation, Xingren can make the qi of the fu-organs smooth, which is beneficial to the dispersion and descent of lung qi, thus promoting the recovery of the disease.

3. Gypsum

Gypsum is an assistant drug. It has a pungent and sweet taste, a very cold nature, and enters the lung and stomach meridians. Gypsum has the effects of clearing heat and purging fire, promoting the production of body fluid and quenching thirst. In the Maxing Shigan Decoction, gypsum mainly targets the interior heat manifestation in the syndrome of the prescription. Since the patient sweats and has dyspnea, and there is no severe heat, the so-called "no severe heat" here does not mean there is really no heat. Instead, the heat pathogen has entered the interior and is stagnated in the lung, resulting in excessive heat in the lung. Gypsum can clear and purge the stagnant heat in the lung to relieve the excessive heat accumulation in the lung. At the same time, its very cold nature can also restrict the warm nature of Ephedra and Apricot Kernel, so that the whole prescription will not be overly warm and prevent excessive yin damage while clearing heat.

The dosage of gypsum is also crucial in prescriptions. Generally, the dosage is adjusted according to the severity of the disease to ensure that it can effectively clear away the lung heat without damaging the healthy qi of the human body due to excessive coldness.

4. Licorice Root

Licorice root is the adjuvant drug. It tastes sweet, has a neutral nature, and belongs to the heart, lung, spleen, and stomach meridians. Licorice root has the functions of invigorating the spleen and replenishing qi, moistening the lungs and relieving cough, and harmonizing various drugs. In the Maxing Shigan Decoction, on the one hand, licorice root can invigorate the spleen and replenish qi to protect the qi of the middle jiao spleen and stomach, preventing drugs such as diaphoresis and clearing heat from overly damaging the spleen and stomach. On the other hand, licorice root can also moisten the lungs and relieve cough, enhancing the cough-relieving and asthma-suppressing effects of the formula. It can also harmonize the properties of the three drugs, Ephedra, Apricot Kernel, and Gypsum, enabling them to synergize with each other and better exert the therapeutic effect. Licorice root plays an important role in balancing and coordinating in the formula, making the medicinal power of the whole formula more gentle and comprehensive.

3. Ma Xing Shi Gan Tang Pathogenesis, Efficacy & Indications

1. Pathogenesis Analysis

The pathogenesis targeted by Maxing Shigan Decoction is mainly exogenous wind pathogen, with pathogenic heat congesting the lung. After the human body is affected by the wind pathogen, if the vital qi is relatively insufficient, the wind pathogen is likely to transform into heat in the interior, and the heat pathogen stagnates in the lung, resulting in the dysfunction of the lung's dispersing and descending functions. The lung governs qi and is responsible for respiration. When the lung qi is depressed and closed, asthma symptoms will occur; the lung is exteriorly-interiorly related to the skin and hair. When the lung heat is exuberant, it will also force the body fluid to leak outwards, thus sweating occurs. At the same time, there is heat pathogen in the interior. Although there is a heat manifestation on the body surface, it is not as severely hot as in exterior excess syndrome, so it is manifested as sweating and asthma, without severe heat. This pathogenesis feature is relatively common clinically, especially in the initial or middle stages of some exogenous febrile diseases.

2. Efficacy Explanation

Maxing Shigan Decoction It has the effects of dispersing pathogenic factors with pungent and cool herbs and relieving asthma by clearing the lung. The feature of the compatibility of Ephedra and Gypsum in the formula is reflected in "dispersing pathogenic factors with pungent and cool herbs". Ephedra is pungent and warm, which can disperse the lung qi and release the exterior pathogenic factors; Gypsum is extremely cold, which can clear away the stagnant heat in the lung. When the two are combined, one is warm and the other is cold, restricting and synergizing with each other. It can not only disperse the exterior pathogenic factors but also clear away the heat in the lung, enabling the lung qi to be smoothly dispersed and the stagnant heat to be cleared. "Relieving asthma by clearing the lung" highlights the therapeutic effect of the formula on the pathological changes of the lung. By using Semen Armeniacae Amarum to lower qi and relieve asthma, and Licorice Root to moisten the lung and relieve cough and harmonize the actions of all the other ingredients in the formula, they jointly achieve the purpose of clearing away the lung heat and relieving asthma, and restoring the normal function of the lung.

3. Indicated Diseases

Maxing Shigan Decoction It is mainly used to treat the syndrome of exogenous wind pathogen and excessive heat congesting the lung. Common symptoms include fever, cough, asthma, thirst, sweating, etc. These symptoms are clinically common in respiratory diseases such as colds, bronchitis, pneumonia, etc. For example, during a cold, if the patient originally catches wind-cold pathogen, but due to constitutional factors or improper treatment, the wind pathogen quickly transforms into heat and enters the interior, presenting the above symptoms, the Maxing Shigan Decoction can be considered for treatment. For patients with bronchitis or pneumonia, if there are manifestations of exuberant lung heat, such as severe cough, obvious asthma, fever without aversion to cold, etc., the Maxing Shigan Decoction can also achieve good therapeutic effects, helping patients relieve symptoms and promoting the recovery of the disease.

4. Analysis of Formula's Meaning

1. Compatibility of Ephedra & Gypsum

The combination of ephedra and gypsum is the core of the Ma Xing Shi Gan Tang formula. Ephedra is warm in nature and excels at ventilating the lungs, relieving asthma, and inducing sweating to expel pathogens. Gypsum is cold in nature and specializes in clearing heat from the lungs. The combination of the two, one warm and one cold, mutually restrains each other. With gypsum restraining it, the warming nature of ephedra is controlled, its diaphoretic effect is weakened, while its lung-ventilating and asthma-relieving effects remain, and excessive sweating can be avoided from harming the body's vital energy. With ephedra, the cold nature of gypsum does not lead to excessive coldness, its heat-clearing effect is stronger, and it can also help the dispersing effect of ephedra to allow the heat in the lungs to dissipate. This combination method not only reflects the ingenuity of traditional Chinese medicine but also fits the pathogenesis of this syndrome, effectively treating fever and asthma caused by exogenous wind-evil and heat accumulation in the lungs.

2. Synergy of Apricot Seed, Ephedra & Gypsum

Almonds cooperate with Ephedra and Gypsum Fibrosum to play a role in relieving cough and asthma synergistically. Ephedra disperses the lung qi and relieves asthma, and almonds descend qi to relieve cough and asthma. One disperses and the other descends, jointly regulating the qi movement of the lung and enhancing the efficacy of relieving cough and asthma. Gypsum Fibrosum clears away the lung heat. When the lung heat is cleared, the lung qi can be purified and descended, helping to relieve the asthma symptoms. The three cooperate with each other, enabling the dispersing and purifying functions of the lung to return to normal, thus achieving the purpose of treating diseases such as asthma and cough. This synergistic effect reflects the relationship of mutual use and complementarity among the drugs in the formula, making the curative effect of the whole formula more remarkable.

3. Licorice Harmonizes Herbs

Licorice Root plays an important role in harmonizing all the drugs in Maxing Shigan Decoction. It can not only harmonize the properties of Ephedra, Almonds, and Gypsum Fibrosum, enabling them to play a better synergistic role, but also tonify the spleen and benefit qi, protecting the middle jiao spleen and stomach. During the process of sweating and clearing heat, the drugs may cause certain damage to the spleen and stomach. Licorice Root can prevent this situation from occurring by tonifying the spleen and benefiting qi, ensuring that while the formula treats diseases, it will not overly damage the healthy qi of the human body. The harmonizing effect of Licorice Root makes the whole formula more gentle and stable, conducive to the treatment of diseases and the recovery of the body.

5. Comparison with Other Similar Formulas

1. Comparison with Mahuang Decoction

Mahuang Decoction It comes from Treatise on Cold Damage Disorders and is also a classic formula for treating exterior syndrome of wind-cold excess pattern. The composed drugs of Mahuang Decoction are Ephedra, Cinnamon Twig, Almonds, and Licorice Root. The main differences between it and Maxing Shigan Decoction lie in the pathogenesis and drug compatibility. The syndrome of Mahuang Decoction is exterior contraction of wind-cold, the defensive yang is inhibited, and the nutrient qi is stagnated. Therefore, the main manifestations are aversion to cold, fever, absence of sweating, and floating and tense pulse. The treatment is mainly to relieve the exterior syndrome by sweating. Ephedra and Cinnamon Twig are used together, with a stronger sweating power. While the syndrome of Maxing Shigan Decoction is exogenous wind pathogen and heat congestion in the lung, characterized by sweating and asthma, and no severe heat. The treatment focus is on clearing away the lung heat and dispersing the lung qi. The compatibility of Ephedra and Gypsum Fibrosum, one warm and one cold, emphasizes clearing and dispersing the lung heat. There are obvious differences in their pathogenesis, efficacy, main treatment, and drug compatibility. When applying clinically, it is necessary to accurately differentiate and select according to the specific condition.

2. Comparison with Sangju Decoction

Mulberry Leaf and Chrysanthemum Decoction It is also a commonly used formula for treating mild syndrome of exogenous wind-heat. Its composition includes Mulberry Leaf, Chrysanthemum, Almonds, Forsythia, Mentha Haplocalyx, Platycodon Grandiflorum, Licorice Root, and Reed Rhizome. Mulberry Leaf and Chrysanthemum Decoction focuses on dispersing wind-heat and clearing the head and eyes, mainly used for treating the syndrome of wind-warm at the initial stage with pathogenic factors invading the lung collaterals, with the main symptoms of cough, mild body heat, and slightly thirsty mouth. Maxing Shigan Decoction focuses on clearing away the lung heat and relieving cough and asthma, applicable to the syndrome of exogenous wind pathogen and heat congestion in the lung, with symptoms mainly including fever, cough, asthma, and sweating. Although both are related to exogenous wind-heat, there are differences in their pathogenesis, efficacy, and main treated diseases. When applying clinically, it should be differentiated and selected according to the specific symptoms and signs of the patient.

6. Clinical Applications and Indications

1. Respiratory Diseases

In terms of colds, if a patient shows symptoms such as fever, slight aversion to wind-cold, cough, asthma, thirst, and sweating after catching a cold, and after syndrome differentiation belongs to the syndrome of exogenous wind pathogen and heat congestion in the lung, Maxing Shigan Decoction can effectively relieve the symptoms. For bronchitis, especially acute bronchitis, when the patient shows symptoms of severe cough, unsmooth expectoration, asthma, and fever with excessive heat congestion in the lung, Maxing Shigan Decoction can play the role of clearing the lung and resolving phlegm, relieving cough and asthma. In the treatment of pneumonia, Maxing Shigan Decoction also has certain application value. For the initial or middle stage of pneumonia, with symptoms such as high fever, cough, shortness of breath, and flaring of the alae nasi, and differentiated as heat congestion in the lung by traditional Chinese medicine, Maxing Shigan Decoction can be used in combination with other drugs for clearing heat and detoxifying, resolving phlegm and relieving cough to enhance the curative effect and promote the recovery of pneumonia.

2. Other Conditions

In addition to respiratory diseases, Maxing Shigan Decoction is also applied in some other conditions. For example, in skin diseases, if there are rubella, eczema, etc. caused by the steaming of lung heat on the skin, accompanied by symptoms such as fever, itching, thirst, etc., Maxing Shigan Decoction can clear the lung and purge heat to achieve the effect of dispelling wind and relieving itching. In ophthalmic diseases, for symptoms such as red and swollen eyes and unclear vision caused by the disturbance of lung heat, if the syndrome differentiation is accurate, Maxing Shigan Decoction can also be modified and applied to clear away lung heat and relieve ocular symptoms. In addition, in pediatric diseases, for conditions such as exogenous fever and cough with dyspnea in children, if they conform to the pathogenesis of Maxing Shigan Decoction syndrome, using this formula can also achieve good therapeutic effects.

7. Modifications

1. Severe Lung Heat

If the lung heat is relatively severe, the dosage of gypsum can be increased to enhance the effect of clearing away lung heat. At the same time, herbs for clearing heat and purging fire such as scutellaria baicalensis and anemarrhena asphodeloides can be added to further strengthen the heat-clearing power. Scutellaria baicalensis is bitter in taste, cold in nature, and belongs to the lung, gallbladder, spleen, large intestine, and small intestine meridians, with the effects of clearing heat and drying dampness, purging fire and detoxifying; Anemarrhena asphodeloides is sweet and bitter in taste, cold in nature, and belongs to the lung, stomach, and kidney meridians, capable of clearing heat and purging fire, promoting the production of body fluid and moistening dryness. When combined with gypsum, they can more effectively clear away lung heat.

2. Severe asthma

When dyspnea is obvious, the dosages of ephedra and almond can be increased to enhance the effect of relieving asthma and cough. Herbs for descending qi and relieving asthma such as semen lepidii and semen perillae can also be added. Semen lepidii is pungent and bitter in taste, extremely cold in nature, and belongs to the lung and bladder meridians, capable of purging the lung and relieving asthma, promoting diuresis and reducing swelling; Semen perillae is pungent in taste, warm in nature, and belongs to the lung and large intestine meridians, having the effects of descending qi and resolving phlegm, relieving cough and asthma, and moistening the intestines and promoting defecation. The addition of these herbs can synergistically relieve dyspnea symptoms with ephedra and almond better.

3. Excessive phlegm

When there is excessive phlegm, herbs for resolving phlegm such as fructus trichosanthis, fritillaria cirrhosa, and pinellia ternata can be added. Fructus trichosanthis is sweet and slightly bitter in taste, cold in nature, and belongs to the lung, stomach, and large intestine meridians, capable of clearing heat and removing phlegm, widening the chest and dissipating nodules, moistening dryness and lubricating the intestines; Fritillaria cirrhosa is bitter and sweet in taste, slightly cold in nature, and belongs to the lung and heart meridians, having the effects of clearing heat and resolving phlegm, moistening the lung and relieving cough, and dissipating nodules and swelling; Pinellia ternata is pungent in taste, warm in nature, and toxic, belonging to the spleen, stomach, and lung meridians, capable of drying dampness and resolving phlegm, descending adverse qi and stopping vomiting, and dissipating masses and nodules. They can enhance the phlegm-resolving effect of the formula, expel phlegm, and relieve symptoms such as cough and dyspnea.

8. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional method

When using Maxing Shigan Decoction in the traditional way, generally, the four herbs of ephedra, almond, gypsum, and licorice are weighed according to a certain proportion, and then decocted with water. Usually, the dosage of ephedra is 9 grams, almond 9 grams, gypsum 18 grams, and licorice 6 grams. First, put ephedra, almond, and licorice into the pot, soak in water for about 30 minutes, then bring to a boil over high heat, and then change to low heat and decoct for 20 - 30 minutes. After that, add gypsum and continue to decoct for 10 - 15 minutes. After decocting, remove the residue and take the decoction, and take it warm in two doses. This traditional decocting method can fully extract the effective components of the herbs and exert the therapeutic effect of the formula.

2. Modern concentrated granules

Modern concentrated granules are granule preparations made from traditional Chinese medicines through processes such as extraction and concentration, which are convenient to take. When using the concentrated granules of Maxing Shigan Decoction, generally take them according to the recommended dosage in the instructions. The specifications of the concentrated granules produced by different manufacturers may vary, but the general drug composition and proportion are consistent with the traditional formula. For example, some concentrated granule preparations are equivalent to 10 - 15 grams of the crude drug per bag, and patients can take them by dissolving in warm water and taking orally 2 - 3 times a day according to the condition and the doctor's advice. Modern concentrated granules retain the effective components of traditional Chinese medicines and are convenient to take, suitable for the modern fast-paced lifestyle, but also need to follow the doctor's advice and pay attention to the dosage and treatment course when using.

9. Precautions and Taboos

1. Use with caution for the weak

In Maxing Shigan Decoction, the properties of herbs such as ephedra and gypsum are relatively drastic. For those with weak constitutions, especially those with qi and blood deficiency and spleen and stomach deficiency-cold, using it may further damage the healthy qi and lead to a weaker body. Therefore, such people should consult a doctor before using and choose carefully.

2. Contraindicated for wind-cold exterior syndrome without interior heat

If the patient only has exogenous wind-cold and there are no manifestations of interior heat, such as severe aversion to cold, mild fever, no sweating, not thirsty, etc., using Maxing Shigan Decoction not only cannot treat the disease, but may even aggravate the condition due to the bias of the drug. Therefore, accurate syndrome differentiation must be carried out to avoid misapplication.

Diet Taboos during Medication

During the period of taking Maxing Shigan Decoction, it is necessary to avoid eating spicy, greasy and stimulating foods, such as chili peppers, fried foods, etc. These foods may aggravate the heat pathogen in the body and affect the therapeutic effect of the medicine. At the same time, attention should be paid to a light diet and drinking more water, which is helpful for the recovery of the illness.

10. Modern Research Progress

Pharmacological Action Research

Modern pharmacological research shows that Maxing Shigan Decoction has various pharmacological effects. Ephedrine in Ephedra sinica has effects such as exciting the central nervous system, constricting blood vessels, raising blood pressure, and relaxing bronchial smooth muscle; amygdalin in almonds can produce hydrocyanic acid after enzymatic hydrolysis, which has the effect of relieving cough and asthma; Gypsum Fibrosum has the effects of clearing heat and purging fire, reducing body temperature, etc.; components such as glycyrrhizin and glycyrrhetinic acid in Licorice Root have effects such as anti-inflammatory, anti-allergic, and regulating immunity. These pharmacological effects work together to enable Maxing Shigan Decoction to exert a comprehensive therapeutic effect in the treatment of related diseases.

Clinical Efficacy Verification

A large number of clinical studies have verified the clinical efficacy of Maxing Shigan Decoction. In the treatment of respiratory diseases such as colds, bronchitis, and pneumonia, Maxing Shigan Decoction can significantly relieve symptoms such as fever, cough, and asthma, shorten the course of disease, and improve the cure rate. For example, some studies have shown that the combination of Maxing Shigan Decoction and western medicine in the treatment of pediatric pneumonia can significantly improve the clinical symptoms of children, shorten the time for the disappearance of pulmonary rales and the length of hospitalization, and has good safety. In the treatment of other diseases such as skin diseases and ophthalmic diseases, Maxing Shigan Decoction also shows certain treatment advantages, providing more evidence support for its clinical application.

Dosage Form Improvement and Innovation

With the development of modern technology, the dosage form improvement and innovation of Maxing Shigan Decoction are also continuously carried out. In addition to the modern concentrated granules mentioned above, some studies have made Maxing Shigan Decoction into dosage forms such as oral liquid, capsules, and dripping pills. While maintaining the efficacy of the prescription, these new dosage forms have the advantages of convenient administration, accurate dosage, good stability, etc., and are more in line with the needs of modern clinical medication. For example, the dripping pills of Maxing Shigan Decoction improve the dissolution rate and bioavailability of the medicine through optimizing the preparation process, providing more medication options for patients.

Summary of Maxing Shigan Decoction

Ma Xing Shi Gan Tang, also known as the Ephedra and Gypsum formula, is a traditional Chinese medicine formula that serves as an exterior-releasing formula while clearing lung heat and relieving asthma. It clears lung heat, calms panting, and restores the descending function of lung qi to address patterns where heat obstructs the lung, interior heat, and pathogenic heat.

The formula relieves symptoms such as wheezing, bronchial asthma, persistent fever, fever, thirst, and rapid pulse, and is effective for acute bronchitis, bronchitis, upper respiratory tract infection, common cold, and measles complicated by pneumonia, often with a yellow tongue coating. Key herbs include ma huang (ephedra), xing ren (apricot kernel), shi gao (gypsum), and zhi gan cao (licorice).