Xuán Fù Dài ZhěTāng

Original Text:
    In a case of cold damage with sweating, if [the patient has been treated by inducing] vomiting and precipitation, [after which] there is glomus in the epigastrium and persistent belching, Xuán Fù Dài ZhěTāng is the governing formula.

Explanation:
    This pattern [of illness] is stomach vacuity with phlegm obstruction, vacuous qi. and upbearing counterflow.  “Persistent belching” is the distinguishing feature [among this set of symptoms] which proves the pattern. “Persistent belching” means two things:  1) belching is continuous without pause and occurs frequently; 2) hard glomus in the epigastrium is not reduced by belching. 
    This formula supplements vacuity, harmonizes the Stomach and transforms fluids as well as downbearing counterflow and calming the Liver.  The formula contains dai zhe shi, xuan fu hua, and sheng jiang with doses in a ratio of 1:3:5.  In clinical application [one is discouraged from] carelessly modifying [this ratio].  This formula has been used extensively in treatment of a variety of illnesses including belching, retching, dizziness and also reflux patterns.

Case 3, Retching & Dizziness
Dr. Jun Chen Song

    The case dates from 1958 regarding a 15 year old female:  After the patient suffered meningitis, dizziness & forgetfulness [symptomatic of meningitis] were not completely cured.   Currently, wind strike has brought out the previous illness, and the momentum is quite strong.  [The patient suffers] dizziness & headache, her vision is dark & clouded, her eyes are closed, she cannot see. [She feels] as if she is sitting in a boat; when she moves she feels dizzy and falls to the ground.  Even when supported by the arm [of another] the patient still cannot walk, and sometimes there is retching.  A classmate of the patient carried her on his back to come to the clinic. 
    Upon examination [one] sees both eyes are slightly red, the tongue coat is white & slippery, the pulse is stringlike, fine & slow.  This [disease presentation] is Liver vacuity with wind stirring, Spleen dampness generating phlegm, wind and phlegm have bound together blocking the clear orifices.  Although there is an EPI contraction [as an element of the pathomechanism] by studying carefully we know that [the elements of] excess are limited and the vacuity is great.  Treat [the patient] in order to restrain [what is] floating & calm counterflow, support Yin and subdue the Yang, move & transform turbid phlegm, and course the exterior.  Use Xuán Fù Dài ZhěTāng adding shao yao, gou teng & ju hua. 
    In one day & night the patient took 2 bags [of the formula].  After noon of the 2nd day immediately [the patient] was able to get out of bed.  The pulse and signs had taken a significant turn for the better.  [After] continuing with the original formula for one week [the patient] recovered.  Thereafter, [the treatment principle was altered to] regulate and [support] recovery using formulas to enrich & supplement.

Commentary:  From a chapter from Su Wen [Nei Jing]:  “wind, shaking, and dizziness all belong to Liver. “ Liver vacuity and wind stirring with phlegm harassing upward to block the clear orifices causes this disease.  Xuán Fù Dài ZhěTāng strongly calms the Liver and downbears counterflow.   However, it is not strong to calm the Liver & stop wind, therefore add bai shao, gou teng, & ju hua to assist [for this condition].

Source:  Shāng Hán Míng Yàn Àn Jīng Xuǎn 
Selected Cases from Famous Doctors in the Shang Han Tradition, ©1998, pg243-245.
Editors:  Ming Chen, Dr. Zhang Yin
Translation:  Amy Darling