Ma Huang Fu Zi Xi Xin Tang: A Classic TCM Formula for Warming Yang and Herbal Remedies for Colds
- Health Lab
- Mar 6
- 7 min read
Updated: Apr 25
Ma Huang Fu Zi Xi Xin Tang is a time-honored traditional Chinese medicine (TCM) prescription and Herbal Remedies for Colds from the Han Dynasty, documented in Zhang Zhongjing’s Treatise on Febrile Diseases. The text notes, “For Shao Yin disease with fever and a deep pulse at the onset, Ma Huang Fu Zi Xi Xin Tang is the primary treatment.”
This formula is designed for individuals with Yang deficiency who develop cold symptoms after exposure to wind and cold. It addresses conditions classified as “Shao Yin disease” (internal cold due to Yang deficiency) often combined with “Tai Yang disease” (external wind-cold symptoms), making it a powerful remedy for restoring warmth and balance.
Composition of the Formula Herbal Remedies for Colds
Ma Huang Fu Zi Xi Xin Tang consists of three key herbs, structured according to the TCM principle of “monarch, minister, assistant, and envoy”:
Monarch Herb:
Ma Huang (Ephedra): Promotes sweating to expel wind-cold pathogens from the body’s surface, relieving external symptoms like chills and body aches.
Minister Herb:
Fu Zi (Aconite): Warm and pungent, it invigorates kidney Yang, dispels internal cold, and strengthens the body’s vital energy, ideal for Yang-deficient individuals.
Assistant Herb:
Xi Xin (Asarum): Clears both external and internal cold, supports Ma Huang in relieving surface symptoms, and stimulates kidney Yang to enhance warmth.
These herbs work synergistically to dispel external wind-cold while warming and preserving internal Yang, effectively treating “cold inside and out.”
Indications
Ma Huang Fu Zi Xi Xin Tang targets cold symptoms in individuals with Yang deficiency, where low internal warmth makes them vulnerable to external wind-cold invasion. Common symptoms include:
Fever with chills or sensitivity to cold.
Cold or lukewarm limbs.
Headache, nasal congestion, sore throat, or cough.
Body aches, muscle soreness, or joint pain.
Fatigue, lethargy, or difficulty sweating.
Thin white or greasy tongue coating and a deep, tight, or floating pulse.
The formula is particularly suited for conditions involving Yang deficiency combined with external wind-cold, such as colds, flu, or pain triggered by cold exposure.
Therapeutic Effects (Herbal Remedies for Colds)
Ma Huang Fu Zi Xi Xin Tang excels in:
Boosting Yang and Relieving Exterior Symptoms: Ma Huang induces sweating to expel wind-cold, clearing surface symptoms like fever and chills.
Warming Meridians and Dispelling Cold: Fu Zi warms the kidneys and channels, counteracting internal cold and restoring Yang energy.
Supporting Qi Flow: Xi Xin enhances the formula’s ability to clear both external and internal cold, promoting circulation and kidney vitality.
This combination disperses external pathogens while reinforcing internal warmth, restoring balance and alleviating discomfort caused by cold and Yang deficiency.
Modern Applications
In modern medicine, Ma Huang Fu Zi Xi Xin Tang is widely used to treat conditions linked to cold obstruction and Yang deficiency, including:
Respiratory Issues: Colds, flu, asthma, bronchitis, and chronic cough.
Neurological and Pain Conditions: Migraines, neuralgia, joint rheumatism, sciatica, back pain, and fibromyalgia.
Cardiovascular and Circulatory Disorders: Hypertension, bradycardia, and heart disease.
Allergic and Inflammatory Conditions: Allergic rhinitis, urticaria, and sore throat.
Other Conditions: Early-stage nephritis, kidney stones, edema, sudden muteness, sudden blindness, and measles with pneumonia.
By warming Yang, expelling cold, and relieving symptoms, the formula effectively addresses these diverse ailments, improving patient comfort and supporting recovery.
Precautions for Use
When using Ma Huang Fu Zi Xi Xin Tang, consider the following:
Yang Deficiency Caution: In severe Yang deficiency with symptoms like diarrhea, cold limbs, or weak pulse, prioritize warming the interior before treating external symptoms to avoid Yang depletion. Improper sweating can be dangerous.
Timing: Avoid taking the formula at night, as Ma Huang’s stimulating effects may cause insomnia.
Normal Reactions: Frequent urination is a common and expected response to the formula’s diuretic properties.
Medical Supervision: Due to the potent nature of Ma Huang and Fu Zi, use under a doctor’s guidance to ensure safe dosing and suitability.
Chinese Name | 麻黃細辛附子湯 |
Phonetic | Ma Huang Fu Zi Xi Xin Tang |
English Name | Ephedra, Aconite and Asarum Decoction |
Classification | Exterior-releasing formulas |
Source | 《Treatise on Cold Damage》Shang Han Lun《傷寒論》 |
Combination | Ephedrae Herba (Ma Huang) 2 liang (6g), Aconiti Lateralis Radix Praeparata (Fu Zi pao) 1 whole piece broken into 8 pieces (9g), Asari Radix et Rhizoma (Xi Xin) 2 liang (3g) |
Method | Prepare it as a decoction. The decoction should be taken warm. |
Action | Assists yang to release the exterior. |
Indication | 1. This formula is indicated for patterns of yang-deficiency with externally contracted wind-cold. Signs and symptoms include fever, severe aversion to cold that does not improve even with thick layer of clothes and a quilt, lassitude, lethargy, and a deep and tiny pulse. 2. It is also indicated for a sudden loss of voice. Signs and symptoms include a sudden onset of a harsh voice, loss of voice, severe sore throat, aversion to cold, fever, lassitude, and lethargy. A pale tongue with a white coating and a deep and forceless pulse. |
Pathogenesis | This formula is used for patterns of external wind-cold in a person with a yang-deficient constitution. Symptoms caused by exterior wind-cold pathogens struggling with zheng qi are fever and severe aversion to cold that are not resolved even when the patient is wearing a thick layer of clothes or a quilt. The deep and forceless pulse, lassitude, and lethargy are evidence of yang deficiency. Therefore, the treatment needs to simultaneously assist yang and release the exterior. |
Clarification | 1. About the combination of ma huang and fu zi Inducing sweat is the proper treatment method used for exterior patterns. However, in cases of yang deficiency, the body is not able to drive out the pathogens. There is also concern of leaking the already deficient yang when inducing sweat, which might possibly lead to yang collapse. Therefore, both yang-assisting and exterior-releasing methods must be applied in conjunction with each other in order to expel the pathogens without jeopardizing zheng, and enrich zheng without hindering the effort of expelling pathogens. In this formula, ma huang, with its exterior effect, opens the pores to expel the pathogens. Fu zi, which is more of an interior medicinal, rejuvenates yang qi so it can dispel the pathogens. With the two combined, they create mutual synergy. In addition, ma huang is a drastic sweat-inducing medicinal that may damage the yang qi in yang-deficient people. Fu zi, on the other hand, not only assists the yang to expel the pathogens, but it also prevents yang qi from leaking out. When ma huang and fu zi are combined, it eases the concern of yang collapse. Therefore, they make a common combination for assisting yang and releasing the exterior. 2. Why does the formula treat sudden loss of voice? The throat, with the shaoyin kidney channel passing along the base of the tongue, is the gate of the lung system. Therefore, a sudden loss of voice is due to extreme cold directly attacking the lung and kidney, blocking the upper orifices and kidney qi. Ma huang dissipates cold and diffuses lung qi, fu zi warms and enhances kidney yang, and xi xin assists them both in order to unblock the upper and lower conduits. The combination of the three diffuses the lung above, warms the kidney below, and opens up blocked orifices. It is a flexible formula exerting the spirit of “treating different diseases with the same method” by taking care of both the exterior and interior, or both the upper and lower systems. |
Application | 1. Essential pattern differentiation This is both a delegate and fundamental formula indicated for the pattern of shaoyin yang deficiency with externally contracted wind-cold. It is commonly used to treat sore throat and harsh voice caused by a pattern of extreme cold attacking and residing in the lung and the kidney. This clinical pattern is marked by severe aversion to cold, low fever, lassitude and lethargy, and deep pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of a pattern of externally contracted pathogens in a yang-deficient constitution: common cold, flu, bronchitis, sick sinus syndrome, rheumatic arthritis, allergic rhinitis, sudden blindness, sudden aphonia, laryngitis, and skin pruritus. 3. Cautions and contraindications If there is shaoyin yang deficiency with signs such as watery diarrhea containing indigested food, extremely cold limbs, and a feeble impalpable pulse, we must follow the principle of “warming the interior prior to fighting the exterior” addressed by Zhang Zhong-jing. If the sweat-inducing method was to be mistakenly used in this situation, it would lead to yang collapse. Therefore, we have to take extra precaution. |
Additonal formulae | 1. Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite and Licorice Decoction, 麻黃附子甘草湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Ma huang (node removed) 2 liang (6g), zhi gan cao 2 liang (6g), zhi fu zi 1 piece broken into 8 pieces (6g) [Preparation and Administration] Prepare it as a decoction. Ma huang should be decocted first and the foam that collects at the top of the decoction needs to be removed before adding the other medicinals. The decoction should be taken warm. [Actions] Assists yang to release the exterior. [Applicable Patterns] Shaoyin yang deficiency and externally contracted wind-cold. Symptoms include: aversion to cold, body aches, low fever, facial edema, body edema, shortness of breath, difficult urination, and a deep and small pulse. 2. Zai Zao San (Renewal Powder, 再造散) [Source]《Six Texts on Cold Damage》Shang Han Liu Shu《傷寒六書》 [Ingredients] Huang qi 6g, ren shen 3g, gui zhi 3g, gan cao 1.5g, shu fu zi 3g, xi xin 2g, qiang huo 3g, fang feng 3g, chuan xiong 3g, wei jiang 3g, bai shao (chao) 2g [Preparation and Administration] Add 2 pieces of da zao and prepare it as a decoction. Take it while it is warm. [Actions] Releases the exterior, dissipates cold, assists yang, and boosts qi. [Applicable Patterns] Deficient and weak yang qi with externally contracted wind-cold. Symptoms include: aversion to cold, chills more than fever, no perspiration, cold limbs, fatigue, lassitude, sleepiness, a pallor face, and a low voice. The tongue is pale with a white coating, and the pulse is deep and forceless or superficial, large and forceless. |
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