Chai Hu Gui Zhi Gan Jiang Tang — Bupleurum, Cinnamon Twig & Dried Ginger Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions

Overview

Chai Hu Gui Zhi Gan Jiang Tang — the “Bupleurum, Cinnamon Twig and Dried Ginger Decoction” — is from Zhang Zhongjing’s Shang Han Lun. It addresses the Shao Yang pattern complicated by injury to Spleen Yang with retention of Water: alternating chill-fever still present, but now with no thirst (or thirst without desire to drink), no appetite, abdominal fullness, mild oedema and loose stools. The pattern often arises when a Shao Yang illness has been incorrectly purged or otherwise injured the middle Yang.

I prescribe Chai Hu Gui Zhi Gan Jiang Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Chai Hu Gui Zhi Gan Jiang Tang is prescribed for Shao Yang with Spleen-Yang injury and water retention:

• Alternating chills and fever with chill predominant
• No thirst, or thirst without desire to drink
• Sense of cold in the abdomen, mild epigastric fullness
• Loose stools, no appetite
• Mild peripheral oedema, possible palpitations
• Sweating in upper body only, despite chill
• Tongue — pale, white slippery coat
• Pulse — wiry but thin

Key herbs

1. Chai Hu (Rx. Bupleuri, 6–12g) — harmonises Shao Yang; releases the half-exterior
2. Gui Zhi (Ram. Cinnamomi, 6–9g) — warms and unblocks the channels
3. Gan Jiang (Rz. Zingiberis, 3–9g) — warms the middle Yang
4. Tian Hua Fen (Rx. Trichosanthis, 6–12g) — generates fluids (despite the warming pattern)
5. Huang Qin (Rx. Scutellariae, 6–9g) — clears Shao Yang Heat
6. Mu Li (Concha Ostreae, 9–30g) — calms; addresses water collection (a Jin Gui usage)
7. Zhi Gan Cao (Rx. Glycyrrhizae Preparata, 3–6g) — harmonises

Formula actions

1. Harmonises the Shao Yang
2. Warms Spleen Yang and disperses cold-water
3. Generates fluids; addresses paradoxical no-thirst

Conditions treated

1. Persistent low-grade fever after viral illness with cold pattern
2. Chronic Lyme disease with alternating chills and Spleen damage
3. Chronic fatigue syndrome with cold pattern and water retention
4. Long COVID with persistent chills, fatigue, no thirst, loose stools
5. Chronic Shao Yang patterns in depleted patients

Cautions

Not appropriate for Heat patterns or Yin-deficient patterns — the warming herbs would aggravate Heat.

Persistent low-grade fever needs medical investigation if not previously evaluated.

Always consult a qualified Chinese herbalist registered with the RCHM.

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