Ge Gen Huang Qin Huang Lian Tang: A Classic Formula for Treating Heat-Related Diarrhea
- Health Lab
- May 22
- 6 min read
Ge Gen Huang Qin Huang Lian Tang comes from Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases), written by the renowned Eastern Han Dynasty physician Zhang Zhongjing. This foundational text in Chinese medicine established the principles of pattern differentiation and treatment.
The formula is used to treat “heat-associated diarrhea” (xie re xia li), where unresolved external pathogens combine with internal heat, causing symptoms like fever, diarrhea with foul-smelling stools, chest discomfort, thirst, shortness of breath, and sweating.
From the perspective of the Six Stages theory, when external pathogens cause a Taiyang (surface) condition, they should be expelled through surface-relieving methods. However, if purgative treatments are mistakenly used, the pathogen can sink into the Yangming (interior) level, leading to heat-associated diarrhea.
At this stage, both surface and internal heat are present, causing fever, chest and abdominal discomfort, thirst, a red tongue with yellow coating, and a rapid pulse. Internal heat disrupts the large intestine’s function, resulting in foul-smelling diarrhea. Since the lungs and large intestine are closely connected, heat in the chest and abdomen can affect the lungs, causing shortness of breath. Treatment requires relieving the surface pathogen while clearing internal heat.
Formula Explanation of Ge Gen Huang Qin Huang Lian Tang
Ge Gen Huang Qin Huang Lian Tang consists of four herbs—Ge Gen, Gan Cao, Huang Qin, and Huang Lian—organized according to the Chinese medicine principle of “monarch, minister, assistant, and envoy”:
Monarch Herb: Ge Gen. Sweet, pungent, and cool, Ge Gen enters the spleen and stomach channels. It relieves surface pathogens by dispersing heat and lifts clear yang qi in the spleen and stomach to stop diarrhea, harmonizing the surface and interior. Ge Gen excels at addressing unresolved surface pathogens and internal heat causing diarrhea.
Supporting Herbs: Huang Qin, Huang Lian. Both bitter and cold, these herbs clear heat, dry dampness, and detoxify. Huang Qin clears heat from the lungs and stomach, while Huang Lian targets heat in the stomach and intestines. Together, they effectively eliminate damp-heat in the intestines, relieving diarrhea. Their cold nature clears internal heat to stop loose stools.
Assistant/Envoy Herb: Gan Cao. Sweet and neutral, Gan Cao moderates and harmonizes the formula, ensuring Ge Gen, Huang Qin, and Huang Lian work together effectively. It also softens the cold nature of the other herbs, protecting stomach qi.
Pathogenesis Analysis of Ge Gen Huang Qin Huang Lian Tang
Ge Gen Huang Qin Huang Lian Tang targets heat-associated diarrhea, where unresolved surface pathogens combine with internal heat.
When external pathogens invade, they typically cause a Taiyang condition, which should be treated with surface-relieving methods. Misusing purgatives can drive the pathogen inward to the Yangming level, resulting in heat-associated diarrhea.
Key pathogenesis includes:
Unresolved Surface Pathogens with Intense Internal Heat: Surface pathogens remain while internal heat builds, causing fever, chest and abdominal discomfort, thirst, a red tongue with yellow coating, and a rapid pulse.
Internal Heat Disrupting the Large Intestine: Heat impairs the large intestine’s function, leading to foul-smelling diarrhea. Heat in the chest and abdomen affects the lungs (connected to the large intestine), causing shortness of breath. Treatment requires relieving surface pathogens and clearing internal heat. Ge Gen lifts clear qi and stops diarrhea, while Huang Qin and Huang Lian clear intestinal heat, supported by Gan Cao’s harmonizing action.
Indications and Effects of Ge Gen Huang Qin Huang Lian Tang
Effects: Relieves surface pathogens, clears internal heat, and stops diarrhea.Main Condition: Unresolved surface pathogens with internal heat causing heat-associated diarrhea.
Symptoms:
Fever and diarrhea with foul-smelling, sticky stools.
Burning sensation at the anus.
Chest and abdominal discomfort.
Thirst and dry mouth.
Shortness of breath and sweating.
Yellowish-red urine.
Red tongue with yellow coating.
Rapid pulse.
Modern Conditions: Acute enteritis, bacterial dysentery, typhoid, gastroenteritis, and inflammatory skin redness, when linked to unresolved surface pathogens and intense internal heat.
The formula works by simultaneously addressing surface and internal heat, harmonizing the body to resolve fever and diarrhea.
Modern Applications
Ge Gen Huang Qin Huang Lian Tang is widely used in modern medicine for conditions involving high fever, diarrhea, and foul-smelling stools, including:
Acute Enteritis: Relieves diarrhea and abdominal pain, improving gut function.
Bacterial Dysentery: Clears damp-heat to stop dysentery and diarrhea.
Typhoid: Reduces high fever and diarrhea, aiding recovery.
Gastroenteritis: Relieves fever and diarrhea by clearing surface and internal heat.
Inflammatory Skin Redness: Clears heat and toxins to reduce skin inflammation.
Precautions
When using Ge Gen Huang Qin Huang Lian Tang, keep the following in mind:
Contraindications: Not suitable for diarrhea without fever, with a deep, slow, or weak pulse indicating a cold-deficiency pattern. Avoid in cold-type diarrhea, as the formula targets heat-related conditions.
Spleen-Stomach Weakness: Use cautiously in patients with weak spleen and stomach to avoid overburdening digestion.
Menstruation Caution: Women should use cautiously during menstruation to avoid affecting menstrual flow or cycle.
Conclusion
Ge Gen Huang Qin Huang Lian Tang, a classic formula from Shang Han Za Bing Lun, excels at relieving surface pathogens, clearing internal heat, and stopping diarrhea. Its precise combination of herbs effectively harmonizes the body, resolving heat-associated diarrhea and related symptoms. Modern research confirms its ability to clear damp-heat and lift clear qi, enhancing its clinical value. Careful attention to contraindications and patient conditions ensures safe and effective use.
Chinese Name | 葛根黃芩黃黄連湯 |
Phonetic | Ge Gen Huang Qin Huang Lian Tang |
English Name | Pueraria, Scutellaria, and Coptis Decoction |
Classification | Heat-clearing formulas |
Source | 《Treatise on Cold Damage》Shang Han Lun《傷寒論》 |
Combination | Puerariae Lobatae Radix (Ge Gen) 0.5 jin (15g), Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 2 liang (6g), Scutellariae Radix (Huang Qin) 3 liang (9g), Coptidis Rhizoma (Huang Lian) 3 liang (9g) |
Method | Decoct ge gen with 8 sheng (1600 ml) of water until the volume shrinks to about 6 sheng (1200 ml). Then decoct the other medicinals in the formula with the ge gen decoction, and boil it down until the volume to about 400 ml. Filter the decoction and take it warm. (Modern use: use water to decoct the medicinals.) |
Action | Releases the exterior and clears the interior. |
Indication | This formula is indicated for diarrhea with fever. The symptoms are diarrhea, fever, smelly, foul, thick, and sticky stool, burning sensation in the anus, panting with sweating, vexing heat in the chest and stomach cavities, thirst, dark urine, a red tongue body with a yellow coating, and a rapid pulse. |
Pathogenesis | This is a pattern of diarrhea with fever, which was caused by inappropriate purging of an exterior taiyang syndrome leading to an inward invasion of the exterior pathogens to the yangming large intestine. You Yi pointed out that “70% of the exterior pathogens invaded inward, leaving the remaining 30% in the fleshy exterior.” Intense heat in the large intestine makes it incapable to conduct and transmit, causing diarrhea with fever, smelly, foul, thick, and sticky stool, and a burning sensation in anus. Since there is an interior-exterior relationship between the lung and large intestine, the heat in the large intestine steams up to the lung to cause panting, and to the fleshy exterior where it steams to cause sweating. Intense heat damages the fluids, which produces a vexing heat, suppressed sensation in the chest, thirst, and scant dark urine. A red tongue with a yellow coating and a rapid pulse are signs of intense interior heat. The characteristic features of this pattern’s pathogenesis is the residual exterior pathogens, intense heat in the large intestine, failure of the large intestine to conduct and transmit, and the heat steaming the lung and fleshy exterior. Therefore, the therapeutic method is to eliminate the residual exterior pathogens from the fleshy exterior, and clear the intense interior heat from the large intestine. |
Application | 1. Essential pattern differentiation Ge Gen Huang Qin Huang Lian Tang is a commonly used formula used to treat heat diarrhea and heat dysentery, either with an exterior pattern or without. This clinical pattern is marked by diarrhea with fever, fever, smelly, foul, thick, and sticky stool, burning sensation in the anus, red tongue body with yellow coating, and rapid pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of diarrhea and dysentery caused by heat in the large intestine: acute gastroenteritis, chronic nonspecific ulcerative colitis, hemorrhagic enteritis, bacillary dysentery, diarrhea caused by measles, rotavirus enteritis, toxic gastroenteritis in children, amebic dysentery, ileotyphus, diabetes mellitus, and diarrhea caused by chemotherapy for malignant tumors. 3. Cautions and contraindications Do not use the formula for patients with deficiency cold patterns of diarrhea and dysentery. |
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