1. Prescription Source & History

1. Ancient Recipe Inheritance

Banxia Baizhu Tianma Decoction originated from 'Treatise on the Spleen and Stomach' written by Li Dongyuan, a famous doctor in the Jin and Yuan dynasties. Li Dongyuan emphasized the crucial role of the spleen and stomach in human health. He believed that 'internal injury to the spleen and stomach gives rise to all diseases'. This formula is an effective one he summarized in his long-term clinical practice for treating dizziness, headache and other diseases caused by weakness of the spleen and stomach and internal obstruction of phlegm-dampness.

2. Historical Evolution

Over time, Banxia Baizhu Tianma Decoction has been continuously developed and improved in the clinical applications of later generations of doctors. Doctors in each dynasty made appropriate adjustments and supplements to the formula according to their clinical experiences. For example, in the use of drug doses, different doctors may vary according to factors such as the specific condition, constitution of the patient and region. At the same time, there has been a deeper understanding and expansion of the applicable scope of the formula. It is not only used to treat dizziness and headache, but also gradually applied to various phlegm-dampness-related diseases.

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

1. King Drugs: Pinellia & Atractylodes

Pinellia ternata has a pungent and warm taste and enters the spleen, stomach and lung meridians. It has the effects of drying dampness and resolving phlegm, and descending adverse qi and stopping vomiting. Its pungent and warm nature can dry dampness and resolve phlegm, and it is a key herb for treating damp phlegm. In Banxia Baizhu Tianma Decoction, Pinellia ternata can dry dampness and resolve phlegm, eliminating the damp phlegm in the spleen and stomach. It is the key herb targeting the pathogenesis of internal obstruction of phlegm-dampness.

Atractylodes macrocephala has a sweet, bitter and warm taste and enters the spleen and stomach meridians. It has the functions of strengthening the spleen and replenishing qi, and drying dampness and promoting diuresis. Atractylodes macrocephala is good at strengthening the spleen and drying dampness, enhancing the transportation and transformation function of the spleen and stomach, and cutting off the source of phlegm production. Combined with Pinellia ternata, one dries the dampness in the spleen, the other resolves phlegm nodules. They are both monarch herbs to treat the root of phlegm-dampness.

2. Minister Drug: Gastrodia

Gastrodia elata has a sweet and neutral taste and enters the liver meridian. It has the effects of calming endogenous wind and stopping convulsions, suppressing hyperactive liver yang, and dispelling wind and dredging collaterals. In this formula, Gastrodia elata mainly plays the role of suppressing hyperactive liver yang and calming endogenous wind and stopping convulsions. Due to internal obstruction of phlegm-dampness, it is easy to cause stirring of liver wind. Gastrodia elata can soothe the liver and calm the wind, relieve symptoms such as dizziness and headache caused by stirring of liver wind upward, and assist the monarch herbs in treating the main diseases. Therefore, it is a minister herb.

3. Assistant Drugs: Poria, Citrus Red

Poria cocos has a sweet, light and neutral taste and enters the heart, spleen and kidney meridians. It has the effects of promoting diuresis to eliminate dampness, strengthening the spleen, and calming the heart. Poria cocos can eliminate dampness and strengthen the spleen, assisting Atractylodes macrocephala to enhance the power of strengthening the spleen and removing dampness, enabling the phlegm-dampness in the body to be better transported and discharged.

Exocarpium Citri Grandis has a pungent and bitter taste and a warm nature and enters the lung and spleen meridians. It has the functions of regulating qi and widening the middle-jiao, and drying dampness and resolving phlegm. Exocarpium Citri Grandis can regulate qi and resolve phlegm. Combined with Pinellia ternata, it enhances the power of resolving phlegm. At the same time, its function of regulating qi helps to smooth the qi mechanism, so that the qi movement promotes the elimination of phlegm. The two are both assistant herbs, assisting the monarch and minister herbs to play a therapeutic role.

4. Guide Drug: Licorice

Licorice root has a sweet and neutral taste and enters the heart, lung, spleen and stomach meridians. It has the effects of strengthening the spleen and replenishing qi, moistening the lung and relieving cough, clearing heat and detoxifying, and coordinating all the herbs in a formula. In Banxia Baizhu Tianma Decoction, licorice root mainly plays the role of coordinating all the herbs in a formula, enabling the various herbs in the formula to cooperate with each other and better play the therapeutic effect. At the same time, licorice root can also strengthen the spleen and replenish qi, enhancing the function of the spleen and stomach, and assisting the monarch and minister herbs to strengthen healthy qi and eliminate pathogenic factors.

III. Pathogenesis, Efficacy & Indications

1. Pathogenesis

The pathogenesis targeted by the Banxia Baizhu Tianma Decoction is mainly weakness of the spleen and stomach, endogenous phlegm-dampness, obstruction of phlegm-turbidity in the middle-jiao, covering the clear orifices above, and stirring up liver wind. The spleen and stomach are the foundation of acquired constitution and the source of qi and blood transformation. If the spleen and stomach are weak and the transportation and transformation are abnormal, then the metabolism of water and dampness will be disordered and accumulate to form phlegm. Phlegm-dampness obstructs the middle-jiao, yang qi fails to ascend, and yin turbidity fails to descend, leading to dizziness. The disturbance of phlegm-turbidity in the clear orifices above can also cause headache. In addition, long-term accumulation of phlegm-dampness is likely to transform into heat and generate wind, internal movement of liver wind, further aggravating symptoms such as dizziness and headache.

2. Efficacy

This prescription has the effects of resolving phlegm and calming wind, strengthening the spleen and eliminating dampness. Through drugs such as Pinelliae Rhizoma Praeparata cum Zingibere (Banxia) and Atractylodis Macrocephalae Rhizoma (Baizhu) for drying dampness and resolving phlegm, Gastrodiae Rhizoma (Tianma) is used to soothe the liver and calm wind, alleviating symptoms such as dizziness and headache caused by phlegm-turbidity and liver wind. At the same time, drugs for strengthening the spleen such as Poria (Fuling) and Atractylodis Macrocephalae Rhizoma enhance the transportation and transformation functions of the spleen and stomach, eliminating the source of phlegm-dampness regeneration, thus achieving the purpose of treating both the symptoms and the root cause.

3. Indicated Diseases

The Banxia Baizhu Tianma Decoction is mainly used to treat the syndrome of wind-phlegm disturbing upward. Clinically common symptoms include dizziness, headache, stuffiness and discomfort in the chest and diaphragm, nausea and vomiting, white greasy tongue coating, taut and slippery pulse, etc. These symptoms are mostly caused by obstruction of phlegm-dampness and upward disturbance of liver wind. Whether it is endogenous phlegm-dampness caused by improper diet and damage to the spleen and stomach, or obstruction of phlegm-dampness caused by emotional disorders and stagnation of liver qi, as long as the above symptoms of wind-phlegm disturbing upward appear, this prescription can be considered for treatment.

IV. Analysis of Formula Principles

1. Dry Dampness to Resolve Phlegm & Strengthen Spleen to Drain Dampness

In the prescription, Pinelliae Rhizoma Praeparata cum Zingibere (Banxia) dries dampness and resolves phlegm, and Atractylodis Macrocephalae Rhizoma (Baizhu) strengthens the spleen and dries dampness. The combination of the two targets the pathogenesis of obstruction of phlegm-dampness in the middle-jiao, starting from two aspects: resolving phlegm and eliminating the source of phlegm generation. The phlegm-resolving effect of Pinelliae Rhizoma Praeparata cum Zingibere (Banxia) directly targets the already formed phlegm-dampness, and Atractylodis Macrocephalae Rhizoma (Baizhu) prevents the continuous production of phlegm-dampness by enhancing the transportation and transformation functions of the spleen and stomach, embodying the principle of treating the disease by seeking the root cause.

2. Suppress Liver Wind

Gastrodiae Rhizoma (Tianma) soothes the liver and calms wind, targeting the liver wind stirred up by obstruction of phlegm-dampness in the middle-jiao. The internal movement of liver wind can lead to aggravation of symptoms such as dizziness and headache. The application of Gastrodiae Rhizoma (Tianma) effectively alleviates this pathological change, calming the liver wind and reducing symptoms such as dizziness and headache.

3. Regulate Qi, resolve phlegm & promote diuresis to strengthen the Spleen

Citri Reticulatae Exocarpium (Juhong) regulates qi and resolves phlegm, and Poria (Fuling) percolates dampness and strengthens the spleen. The qi-regulating effect of Citri Reticulatae Exocarpium (Juhong) helps to resolve phlegm, and at the same time makes the qi mechanism smooth, facilitating the dissipation of phlegm-dampness. The dampness-percolating effect of Poria (Fuling) can enhance the effect of promoting diuresis and dampness elimination, synergistically enhancing the power of strengthening the spleen and eliminating dampness with Atractylodis Macrocephalae Rhizoma, so as to comprehensively remove phlegm-dampness in the body.

4. Harmonize Medicinal Herbs

Glycyrrhizae Radix et Rhizoma (Gancao) harmonizes all the drugs in the prescription, enabling each drug in the prescription to cooperate with each other and exert their effects synergistically. At the same time, Glycyrrhizae Radix et Rhizoma (Gancao) tonifies qi of the spleen and stomach, also helping to enhance the functions of the spleen and stomach and assisting other drugs to better exert their therapeutic effects.

V. Comparison with Other Similar Formulas

1. Comparison with Erchen Decoction

Erchen Decoction It takes drying dampness and resolving phlegm as the main treatment, and is the basic formula for treating the syndrome of phlegm-dampness. Its component drugs are Pinellia ternata, Citrus reticulata, Poria cocos, and Glycyrrhiza uralensis. Its main effects are drying dampness and resolving phlegm, regulating qi and harmonizing the middle jiao. Compared with the Decoction of Pinellia, Atractylodes Macrocephala and Gastrodia, the Erchen Decoction focuses on simple drying dampness and resolving phlegm, while the Decoction of Pinellia, Atractylodes Macrocephala and Gastrodia adds Gastrodia elata for calming liver wind and Atractylodes macrocephala for invigorating the spleen and replenishing qi on this basis, and is more suitable for the conditions of internal obstruction of phlegm-dampness accompanied by upward disturbance of liver wind and weakness of the spleen and stomach.

2. Comparison with Tianma Gouteng Decoction

the Tianma Gouteng Decoction is mainly used for treating the syndrome of hyperactivity of liver yang and upward disturbance of liver wind, and has the effects of calming liver wind, clearing heat and promoting blood circulation, and tonifying the liver and kidney. Its component drugs include Gastrodia elata, Uncaria rhynchophylla, Concha haliotidis, Gardenia jasminoides, Scutellaria baicalensis, Cyathula officinalis, Eucommia ulmoides, Leonurus japonicus, Taxillus chinensis, Caulis polygoni multiflori, and Poria cocos with zhu (prepared with cinnabar). The Decoction of Pinellia, Atractylodes Macrocephala and Gastrodia mainly focuses on resolving phlegm and calming wind, strengthening the spleen and eliminating dampness, and is suitable for symptoms such as dizziness and headache caused by internal obstruction of phlegm-dampness. The pathogenesis and focus of the two are different, and specific symptoms of the patient should be considered when applying clinically.

VI. Clinical Applications and Indications

1. Vertigo

For dizziness caused by obstruction of phlegm-dampness in the middle jiao, patients often feel dizzy and vertigo, with a heavy head as if wrapped, accompanied by chest distress, nausea, white and greasy tongue coating, and taut and slippery pulse. the Decoction of Pinellia, Atractylodes Macrocephala and Gastrodia can effectively resolve phlegm and eliminate dampness, calm liver wind, and relieve dizziness symptoms. When applying clinically, the drug dosage can be appropriately adjusted according to the specific situation of the patient.

2. Headache

Headaches caused by wind-phlegm disturbing upward are manifested as dull and confused headaches, fullness and stuffiness in the chest and epigastrium, vomiting of phlegm and saliva, etc. Banxia Baizhu Tianma Decoction can improve such headache symptoms by resolving phlegm and calming wind, strengthening the spleen and eliminating dampness. During the treatment process, the location and nature of the patient's headache can also be combined to further distinguish the cause of the disease and carry out targeted treatment.

3. Meniere's Disease

Meniere's disease is mainly characterized by episodic vertigo, tinnitus, deafness, and a feeling of fullness in the ear. Traditional Chinese medicine believes that it is mostly related to factors such as obstruction of phlegm-dampness in the middle-jiao and disturbance of liver-yang upward. The effects of Banxia Baizhu Tianma Decoction in resolving phlegm and calming wind, strengthening the spleen and eliminating dampness can relieve the symptoms of patients with Meniere's disease to a certain extent and improve discomfort such as vertigo and tinnitus. During clinical application, other drugs can be combined according to the condition for comprehensive treatment.

4. Hyperlipidemia

Patients with hyperlipidemia often have manifestations of internal accumulation of phlegm-dampness, such as obesity, chest tightness, abdominal distension, etc. The function of Banxia Baizhu Tianma Decoction in strengthening the spleen and eliminating dampness helps regulate lipid metabolism and improve phlegm-dampness symptoms. Modern research shows that some drugs in this formula may have a certain regulatory effect on blood lipids and can be used as one of the prescriptions for adjuvant treatment of hyperlipidemia.

VII. Modified Pinellia and Gastrodia Decoction

1. Excessive Phlegm-Heat

If the patient has excessive internal heat of phlegm, heat-clearing and phlegm-resolving herbs such as Scutellaria baicalensis, Atractylodes lancea, Phellodendron amurense, and Arisaema cum Bile can be added. Scutellaria baicalensis clears heat and dries dampness, purges fire and detoxifies; Arisaema cum Bile clears heat and resolves phlegm, calms wind and relieves convulsions. Adding the two to the formula can enhance the power of clearing heat and resolving phlegm and more effectively treat diseases caused by internal disturbance of phlegm-heat.

2. Blood Stasis Blockage

When symptoms of blood stasis obstruction appear, such as a fixed headache location, stabbing pain, or accompanied by a purplish and dull tongue, ecchymosis, petechiae, etc., blood-activating and stasis-removing drugs such as Ligusticum chuanxiong, Alisma orientale, and Salvia miltiorrhiza can be added. Ligusticum chuanxiong promotes blood circulation and qi movement, dispels wind and relieves pain; Salvia miltiorrhiza promotes blood circulation to remove stasis, dredges meridians and relieves pain. It helps improve blood stasis symptoms, makes qi and blood smooth, and relieves discomfort such as headache.

3. Severe Spleen-Stomach Weakness

If the symptoms of spleen deficiency are more obvious, Codonopsis pilosula, Astragalus membranaceus, etc. can be added to enhance the function of strengthening the spleen and replenishing qi. Codonopsis pilosula (Ginseng) strengthens the spleen and benefits the lungs, nourishes blood and promotes fluid production; Astragalus membranaceus supplements qi and raises yang, secures the exterior and stops sweating. The two can further enhance the spleen function, improve the body's resistance, and promote the recovery of the disease.

4. Hyperactive Liver-Yang

If symptoms of hyperactivity of liver-yang appear, such as distending pain in the head and eyes, bitter taste in the mouth and dry throat, irritability and anger, etc., liver-pacifying and yang-suppressing drugs such as Uncaria rhynchophylla and Concha Haliotidis can be added. Uncaria rhynchophylla clears heat and pacifies the liver, calms wind and relieves convulsions; Concha Haliotidis suppresses liver-yang, clears the liver and improves eyesight. To strengthen the power of suppressing liver-yang and relieve the symptoms caused by hyperactivity of liver-yang.

VIII. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional Method

The traditional usage of Banxia Baizhu Tianma Decoction is to decoct the medicinal slices with water. The general commonly used dosage is: Pinellia ternata 9g, Gastrodia elata 6g, Poria cocos 6g, Citrus reticulata 6g, Atractylodes macrocephala 15g, Licorice root 3g. First, soak the drugs for about 30 minutes, then bring to a boil over high heat, and then change to low heat and decoct for another 20 - 30 minutes. Take the decoction and warm it in two doses. The specific drug dosage can be appropriately adjusted according to factors such as the patient's condition and constitution.

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, just dissolve them with boiling water according to the dosage specified in the instruction manual. For example, the concentrated granule preparation of Banxia Baizhu Tianma Decoction has the same drug composition as the traditional cut crude drugs, and the dosage is also relatively fixed. Generally, take the granule preparation equivalent to the dosage of the original crude drugs each time, and dissolve it in two times. Compared with the traditional decoction method, modern concentrated granules maintain the efficacy of traditional Chinese medicines, save the decoction time, and are more suitable for the modern fast-paced lifestyle.

IX. Precautions and Taboos

1. Dietary Taboos

During the period of taking Banxia Baizhu Tianma Decoction, it is necessary to avoid eating stimulating foods such as raw and cold, greasy, and spicy foods. Raw and cold foods are likely to damage the yang qi of the spleen and stomach, affect the transportation and transformation functions of the spleen and stomach, and are not conducive to the removal of phlegm-dampness; greasy foods are not easy to digest, can increase the burden on the spleen and stomach, and cause the generation of phlegm-dampness inside the body; spicy foods are likely to assist fire and generate phlegm, aggravating the illness.

2. Special Populations

Pregnant women should use Banxia Baizhu Tianma Decoction with caution. Since most of the drugs in the formula are pungent-warm herbs, they may have an adverse effect on the fetus. In addition, those with a weak constitution and hyperactivity of yin with yang exuberance should also use it with caution or under the guidance of a doctor to avoid aggravating the illness due to improper medication.

3. Condition Observation

During the course of taking the medicine, the patient should closely observe the changes in their own symptoms. If symptoms such as dizziness and headache worsen or new discomforts occur, they should seek medical treatment in time and adjust the treatment plan. At the same time, take the medicine on time according to the doctor's instructions, do not increase or decrease the dosage or stop taking the medicine by yourself, and ensure the continuity and effectiveness of the treatment.

X. Modern Research Progress

1. Pharmacological Action Research

Banxia Baizhu Tianma Decoction is a commonly used formula for treating wind-phlegm dizziness and dizzy headache, with the functions of resolving phlegm and calming wind, strengthening the spleen and removing dampness, descending adverse qi and stopping vomiting, and calming liver wind. It is applicable to syndromes such as headache, dizzy headache, nausea and vomiting caused by wind-phlegm disturbing upward. In the formula, Pinellia ternata dries dampness and resolves phlegm, Atractylodes macrocephala strengthens the spleen and removes dampness, Gastrodia elata calms liver wind, Poria cocos, Citrus reticulata Blanco, dried ginger, Medicago sativa, etc. Clinically, it has a good curative effect on dizziness caused by phlegm generated from spleen deficiency and wind-phlegm disturbing upward.

Modern research shows that the drugs in Banxia Baizhu Tianma Decoction have various pharmacological effects. Pinellia ternata has effects such as relieving cough, resolving phlegm, and stopping vomiting; Atractylodes macrocephala can regulate gastrointestinal function, strengthen the spleen and remove dampness, and enhance the body's immunity; Gastrodia elata has effects such as sedation, anti-convulsion, and improving cerebral blood circulation; Poria cocos can promote diuresis and enhance immune function; Citrus reticulata Blanco can regulate qi and resolve phlegm, and regulate gastrointestinal motility; Glycyrrhiza uralensis has effects such as anti-inflammatory and anti-allergic. These pharmacological effects work together, which helps to explain the mechanism of Banxia Baizhu Tianma Decoction in treating related diseases.

2. Clinical Efficacy Verification

Multiple clinical studies have confirmed the effectiveness of Banxia Baizhu Tianma Decoction in treating diseases such as dizziness, headache, and Meniere's disease. Through the observation and analysis of a large number of patients, it is found that this formula can significantly improve the symptoms of patients and improve the quality of life. For example, in the treatment of dizziness, compared with the western medicine control group, Banxia Baizhu Tianma Decoction can relieve dizziness symptoms faster and has a lower recurrence rate.

3. Research on Dosage Form Improvement

With the development of modern technology, the dosage form improvement of Banxia Baizhu Tianma Decoction is also continuously carried out. In addition to the modern concentrated granules mentioned above, some studies have tried to make it into new dosage forms such as capsules and pills. While maintaining the efficacy, these new dosage forms further improve the stability and convenience of taking the medicine, providing more choices for clinical application.

4. Discussion on Action Mechanism

Regarding the mechanism of action of Banxia Baizhu Tianma Decoction, the research is still ongoing. Currently, it is believed that it may exert therapeutic effects through various pathways such as regulating neurotransmitters, improving microcirculation, and regulating lipid metabolism. For example, in improving vertigo symptoms, it may be related to regulating the microcirculation of the inner ear and affecting the release and transmission of neurotransmitters. In-depth research on its mechanism of action will help further optimize the clinical application of the formula and improve the therapeutic effect.