Xiao Chai Hu Tang: A Time-Honored Chinese Herbal Blend for Balance and Wellness

Health Lab
Feb 1
9 min read

Updated: Apr 30

Xiao Chai Hu Tang, a time-honored formula from the ancient Chinese medical text Shang Han Za Bing Lun, is a cornerstone of traditional Chinese medicine.

This herbal blend is designed to treat Shaoyang syndrome, a condition where external pathogens disrupt the body’s balance, leading to symptoms like alternating chills and fever, chest discomfort, and digestive issues. By harmonizing the body’s internal and external energies, soothing the liver, and easing tension, Xiao Chai Hu Tang restores balance and promotes wellness.

Formula Composition

Xiao Chai Hu Tang combines seven carefully selected herbs, each contributing to its therapeutic effects:

Chai Hu (Bupleurum, 24g): Soothes the liver, relieves stress, and balances the Shaoyang energy.
Huang Qin (Skullcap, 9g): Clears heat, reduces inflammation, and alleviates dampness.
Ren Shen (Ginseng, 9g): Boosts energy, strengthens the spleen, and supports digestion.
Zhi Gan Cao (Roasted Licorice, 9g): Harmonizes the formula and softens the effects of other herbs.
Ban Xia (Pinellia, 9g): Dries dampness, clears phlegm, and eases nausea.
Sheng Jiang (Fresh Ginger, 9g): Warms the stomach, relieves nausea, and promotes circulation.
Da Zao (Jujube Dates, 4 pieces): Nourishes the spleen and moderates the formula’s intensity.

How the Herbs Work Together

Chai Hu (Bupleurum): The star of the formula, it smooths liver energy, easing stress and balancing the Shaoyang system to relieve symptoms like irritability and chest tightness.
Huang Qin (Skullcap): With its cooling properties, it clears heat from the gallbladder and lungs, reducing fever and soothing digestive discomfort.
Ren Shen (Ginseng): This energizing herb strengthens the body’s vitality, supports digestion, and enhances resistance to illness.
Zhi Gan Cao (Roasted Licorice): Acts as a mediator, ensuring the herbs work in harmony while protecting the stomach from overly harsh effects.
Ban Xia (Pinellia): Targets nausea, chest fullness, and phlegm, helping to clear blockages and restore comfort.
Sheng Jiang (Fresh Ginger): Warms the digestive system, reduces vomiting, and supports the formula’s ability to clear stagnation.
Da Zao (Jujube Dates): Nourishes the spleen and stomach, softening the formula’s effects to prevent digestive upset.

Main Benefits of Xiao Chai Hu Tang

Xiao Chai Hu Tang is primarily used to treat Shaoyang syndrome, which occurs when external pathogens disrupt the flow of energy, particularly in the liver and gallbladder. Common symptoms include:

Alternating chills and fever
Chest or rib discomfort
Loss of appetite
Irritability
Nausea or vomiting
Bitter taste in the mouth
Dry throat
Dizziness

This formula restores balance by regulating energy flow, supporting liver and spleen function, reducing fever, improving digestion, and boosting immunity.

Xiao Chai Hu Tang /小柴胡湯, 5:1 Concentrated Granules

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Customizing the Formula

Xiao Chai Hu Tang can be tailored to specific symptoms by adding or removing herbs:

Chest discomfort without nausea: Replace Pinellia and Ginseng with Gua Lou (Trichosanthes) to clear heat and ease chest tightness.
Thirst: Swap Pinellia for Tian Hua Fen (Trichosanthes Root) to hydrate and promote saliva.
Abdominal pain: Remove Skullcap and add Bai Shao (White Peony) to soothe the liver and relieve pain.
Abdominal lumps: Omit Jujube Dates and add Mu Li (Oyster Shell) to soften and dissolve masses.
Palpitations and urinary issues: Replace Skullcap with Fu Ling (Poria) to calm the mind and promote urination.
Mild fever without thirst: Remove Ginseng and add Gui Zhi (Cinnamon Twig) to relieve symptoms.
Cough: Omit Ginseng, Jujube, and Ginger, and add Wu Wei Zi (Schisandra) and Gan Jiang (Dried Ginger) to support the lungs.

Modern Applications

Modern research highlights Xiao Chai Hu Tang’s versatility in treating various conditions:

Colds and flu: Its fever-reducing and immune-boosting properties help relieve symptoms.
Chronic liver conditions: Protects the liver and reduces damage in hepatitis or cirrhosis.
Gallbladder issues: Promotes bile flow, easing cholecystitis and gallstones.
Inflammatory conditions: Reduces inflammation in pancreatitis, pleurisy, or otitis media.
Infections: Fights bacteria in conditions like mastitis or orchitis.
Digestive disorders: Soothes bile reflux gastritis and gastric ulcers.

Pharmacological studies show that Bupleurum, Skullcap, and Ginger reduce fever, while Bupleurum, Pinellia, and Skullcap protect the liver, particularly against viral hepatitis.

Xiao Chai Hu Tang /小柴胡湯, 5:1 Concentrated Granules

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The formula also enhances immunity, fights pathogens, reduces inflammation, and may even inhibit certain cancer cells.

Dietary Support

Pairing Xiao Chai Hu Tang with dietary remedies can enhance its effects:

Ginger and Jujube Tea: Warms the stomach and supports digestion, ideal for those with chills and weak digestion.
Barley Porridge: Clears dampness and strengthens the spleen, perfect for digestive discomfort.
Lotus Seed and Lily Soup: Calms the mind and soothes nausea or dry throat.
Mung Bean Soup: Cools the body, great for those with heat-related symptoms.

Precautions

While effective, Xiao Chai Hu Tang should be used cautiously. Long-term use may cause headaches, dizziness, gum bleeding, or pneumonia. It’s not suitable for people with high blood pressure, excessive liver energy, or yin deficiency with bleeding tendencies. The drying nature of Chai Hu, Huang Qin, and Ban Xia may harm those with blood or yin deficiencies.

Conclusion

Xiao Chai Hu Tang is a powerful and versatile remedy in traditional Chinese medicine, effectively addressing Shaoyang syndrome and a range of modern ailments. Its balanced blend of herbs, backed by modern research, highlights its role in promoting health and harmony in the body.

Chinese Name	小柴胡湯
Phonetic	Xiao Chai Hu Tang
English Name	Minor Bupleurum Decoction
Classification	Harmonizing formulas
Source	《Treatise on Cold Damage》Shang Han Lun《傷寒論》
Combination	Bupleuri Radix (Chai Hu) 0.5 jin (24g), Scutellariae Radix (Huang Qin) 3 liang (9g), Ginseng Radix et Rhizoma (Ren Shen) 3 liang (9g), Pinelliae Rhizoma (Ban Xia) 0.5 sheng (9g), Glycyrrhizae Radix et Rhizoma(Zhi Gan Cao) 3 liang (9g), Zingiberis Rhizoma Recens (Sheng Jiang) 3 liang (9g), Jujubae Fructus (Da Zao) 12 pieces (3g)
Method	Decoct the seven medicinals with 12 sheng of water. Boil down to 6 sheng, remove the dregs, and boil further until 3 sheng of water is left. Take 1 sheng of the warm decoction three times a day. (Modern use: prepare as a decoction).
Action	Harmonizes the shaoyang.
Indication	1. Cold damage entering the shaoyang. The symptoms are alternating chills and fever, fullness and discomfort in the chest and rib-side, no desire to eat or drink, vexation and frequent vomiting, bitter taste in the mouth, dry throat, dizzy vision, a thin white tongue coating, and a wiry pulse. 2. Heat entering the blood chamber (uterus). The symptoms are feminine wind-invasion syndrome, inhibited menstrual flow, periodic alternating chills and fever, malaria, and jaundice when the patient shows signs of a shaoyang pattern.
Pathogenesis	The shaoyang channel passes through the chest and covers the rib-side, and is located between the taiyang and yangming. When cold damage invades the shaoyang, which belongs to half-exterior half-interior, struggle between pathogenic qi and zheng qi causes alternating chills and fever. The foot shaoyang channel starts from the inner canthus, a branch enters the chest and diaphragm, connects the liver and gallbladder, and circulates though the rib side of body. Pathogens constrained in the shaoyang transform into heat. Gallbladder fire harasses the upper body, which causes fullness and discomfort in the chest and rib-side, vexation, a bitter taste in the mouth, dry throat, and dizzy vision. When gallbladder heat invades the stomach, it leads to the failure of the stomach qi to harmonize and direct counterflow downward. This causes qi to rise and the patient may lose their desire to eat or drink and develop frequent vomiting and a bitter taste in the mouth. If women contract wind pathogens during their menstrual period, the combination of the inward transmission of pathogenic heat with blood stasis may cause their qi to flow irregularly, cease their menstruation and develop periodic alternating chills and fever. The sweating method can be used to release exterior pathogens, and the emetic and purgative methods are applicable for interior pathogens. However, since the pathogen is located at half exterior and half interior, the sweating, emetic, and purgative methods are all inappropriate. Only the harmonizing method can be used.
Clarification	1. About the Combination of chai hu and huang qin The foot shaoyang channel passes through the chest and covers the rib-side. It is located between the taiyang (exterior) and yangming (interior). When cold damage invades the shaoyang, which belongs to half-exterior half-interior, there will be a dysfunction of the pivot and gallbladder-heat harasses the interior. The treatment is to vent the pathogen, clear heat, and soothe and free the qi. Chai hu enters the liver and gallbladder channels, vents the pathogen from the half-exterior and soothes the qi constrained in the shaoyang. Huang qin also enters the liver and gallbladder channels, clears the half-interior gallbladder-heat in the shaoyang. Chai hu focuses on the half-exterior pathogen and huang qin focuses on half-interior heat. These two medicinals can regulate and free the movement of qi, simultaneously vent and clear the pathogen, and constitute the basic combination that harmonizes the shaoyang. 2. About the preparation: Why it is necessary to “remove the dregs and boil the decoction again” when preparing Xiao Chai Hu Tang? Xiao Chai Hu Tang is the representative formula for harmonizing the shaoyang. The medicinals in the formula embody the principle of dual-direction regulation. For example, it uses both cold and warm medicinals simultaneously (the nature of chai hu and huang qin are cold, while the nature of sheng jiang, ban xia, ren shen, da zao, and zhi gan cao are warm). It treats the half-exterior and half-interior simultaneously (chai hu and sheng jiang vent the half-exterior pathogen, while huang qin clears half-interior heat). It treats deficiency and excess simultaneously (chai hu, huang qin, sheng jiang, and ban xia vent pathogen, clear heat to expel pathogen, while ren shen, da zao, and zhi gan cao boost qi and reinforce zheng qi). “Remove the dregs and boil the decoction again” may be an effort to harmonize the nature of all the medicinals in order to harmonize the gallbladder and stomach, as well as to harmonize the contention between the pathogen and zheng qi. Zhang Zhong-jing originally created this kind of preparation. In addition to Xiao Chai Hu Tang, his other formulas that harmonize the shaoyang and formulas that regulate the stomach and intestines such as Da Chai Hu Tang (Major Bupleurum Decoction), Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction), Sheng Jiang Xie Xin Tang (Fresh Ginger Heart-Draining Decoction), and Gan Cao Xie Xin Tang (Licorice Heart-Draining Decoction) are all using this method.
Application	1. Essential pattern differentiation Xiao Chai Hu Tang is not only the fundamental formula for treating shaoyang syndrome, but also a representative formula for harmonizing shaoyang. This clinical pattern is marked by alternating chills and fever, fullness and discomfort in the chest and rib-side, no desire to eat or drink, vexation and frequent vomiting, bitter taste in the mouth, dry throat, dizzy vision, thin white coating, wiry pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of cold damage located in the shaoyang as well as disharmony of the liver and stomach: cold, influenza, malaria, chronic hepatitis, cirrhosis, acute and chronic cholecystitis, gallstones, acute pancreatitis, pleurisy, otitis media, puerperal fever, acute mastitis, orchitis, and bile reflux gastritis. 3. Cautions and contraindications In this formula, chai hu has an ascending and dissipating action, while huang qin and ban xia have a drying action. Therefore, it should not be prescribed to treat patients with yin or blood deficiency.
Additonal formulae	Chai Hu Zhi Jie Tang (Bupleurum, Orange Fruit and Platycodon Decoction, 柴胡枳桔湯) [Source]《Popular Guide to the Treatise on Cold Damage》Tong Su Shang Han Lun《通俗傷寒論》 [Ingredients] Chai hu 1~1.5 qian (3~4.5g), zhi qiao 1.5 qian (4.5g), ban xia (processed with ginger) 1.5 qian (4.5g), sheng jiang (fresh) 1 qian (3g), huang qin 1~1.5 qian (3~4.5g), jie geng 1 qian (3g), chen pi 1.5 qian (4.5g), yu qian cha 1 qian (3g) [Preparation and Administration] Prepare it as a decoction. [Actions] Harmonizes shaoyang and vents pathogens from the exterior, frees and promotes the chest and diaphragm. [Applicable Patterns] Cold damage entering the shaoyang which is partial to half-exterior half-interior pattern. Symptoms include: alternating chills and fever, temple pain, deafness, dizzy vision, fullness and pain in the chest and rib-side, awhite and glossy tongue coating, wiry and slippery pulse on the right hand, and a wiry, floating and big pulse on the right.
Remark	Ginseng (Panax ginseng) is listed in the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) Appendix II. Its trade is allowed but subject to licensing controls.