Xie Bai San: Clearing Lung Heat and Relieving Cough
Health Lab- May 16
- 5 min read
In treating pediatric illnesses, lung heat cough is a common condition. Xie Bai San, a classic formula for clearing lung heat, is widely used for its simple composition and reliable effectiveness in managing cough, wheezing, and other symptoms caused by lung heat. It is a powerful tool in the hands of pediatric doctors.
Xie Bai San comes from the Song Dynasty physician Qian Yi’s book Xiao’er Yaozheng Zhijue (Key to Pediatric Remedies and Patterns), a key text in Chinese pediatric medicine that laid the foundation for pattern-based treatment in children. This formula is commonly used to treat pediatric lung heat cough.
Historically, Xie Bai San was used to treat lung-related cough and wheezing, with symptoms like coughing, wheezing, steaming hot skin (worse in the late afternoon), a red tongue with yellow coating, and a thin, rapid pulse.
Formula Explanation of Xie Bai San
Xie Bai San’s composition is simple yet effective, following the Chinese medicine principle of “monarch, minister, assistant, and envoy”:
Monarch Herbs: Sang Bai Pi, Di Gu Pi. Sang Bai Pi clears lung heat, reduces swelling, relieves cough, and clears phlegm. Di Gu Pi clears heat, cools blood, reduces steaming heat, stops cough, and calms wheezing. Together, they clear lung heat.
Assistant Herb: Jing Mi (non-glutinous rice). Jing Mi tonifies qi, nourishes the stomach, and generates fluids, protecting the stomach from the cooling effects of other herbs.
Envoy Herb: Zhi Gan Cao (honey-fried licorice). Zhi Gan Cao harmonizes the formula, clears heat, detoxifies, moistens the lungs, and stops cough.
Pathogenesis of Xie Bai San
Xie Bai San targets lung heat that disrupts lung qi movement, leading to cough and wheezing. The pathogenesis can be analyzed in three stages:
Root Cause: Lung Heat: The root issue is heat accumulating in the lungs, caused by external pathogens turning into heat, dietary imbalances creating internal heat, or yin deficiency causing relative yang excess (leading to heat).
Heat Obstructing Lung Qi: Lung heat impairs the lungs’ ability to disperse and descend qi. This obstruction causes qi stagnation, resulting in cough, wheezing, and shortness of breath. Heat also dries lung fluids.
Manifesting Symptoms: Blocked lung qi and dryness lead to characteristic symptoms:
Cough: Due to reversed qi and lung irritation.
Wheezing: Due to obstructed airflow.
Shortness of Breath: Due to the lungs’ inability to efficiently extract qi from air.
Flushed Face: Due to heat rising.
Dry Mouth: Due to heat consuming fluids.
Thick, Yellow Phlegm: Indicates heat and congealed fluids.
Main Effects of Xie Bai San
Xie Bai San is primarily used to treat lung-related cough and wheezing, with specific symptoms including:
Coughing and wheezing
Steaming hot skin, worse in the late afternoon
Red tongue with yellow coating
Thin, rapid pulse
Other possible symptoms: facial swelling, body heat, or intense lung heat (redness on the right cheek, bad breath)
Xie Bai San offers the following key effects:
Clearing Lung Heat: Removes hidden heat from the lungs, restoring clear lung qi.
Stopping Cough and Calming Wheezing: Regulates qi, relieving cough and wheezing.
Promoting Fluid Balance and Reducing Swelling: Clears lung heat and promotes fluid movement to reduce swelling.
Modern Applications
Modern research confirms Xie Bai San’s value in treating conditions involving lung heat and gradual qi and yin depletion, such as:
Early-stage bronchitis
Early-stage pneumonia
Early-stage measles in children
Precautions
When using Xie Bai San, keep the following in mind:
Pattern Differentiation: Chinese medicine emphasizes pattern-based treatment. Consult a Chinese medicine practitioner to confirm suitability for your condition.
Not Suitable for Certain Conditions: Avoid using for cough caused by wind-cold or wheezing due to lung deficiency.
Dosage and Preparation: Follow medical advice. Typically, the herbs are ground into powder, mixed with a pinch of Jing Mi, and boiled in water for consumption.
Dietary Guidelines: Maintain a light diet during treatment, avoiding spicy or stimulating foods.
Conclusion
Xie Bai San, with its simple composition and clear effectiveness, holds an important place in treating pediatric illnesses. Despite its minimal ingredients, its ability to clear heat, stop cough, and calm wheezing is remarkable, making it a trusted ally for doctors managing lung heat cough.
However, its use must follow Chinese medicine’s pattern differentiation principles, with adjustments based on the child’s specific condition, to fully harness its benefits and safeguard children’s health.
Chinese Name | 瀉白散 |
Phonetic | Xie Bai San |
English Name | White-Draining Powder |
Classification | Heat-clearing formulas |
Source | 《Key to Diagnosis and Treatment of Children’s Diseases》Xiao er Yao Zheng Zhi Jue《小兒藥證直訣》 |
Combination | Lycii Cortex (Di Gu Pi) 1 liang (30g), Mori Cortex (Sang Bai Pi dry-fried) 1 liang (30g), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gan Cao) 1 qian (3g) |
Method | Grind the medicinals into a crude powder. Decoct one dose of the formula with a few jing mi and two zhan of water, and boil it until the volume shrinks to about 70%. Take the decoction before meals. (Modern use: use water to decoct the medicinals.) |
Action | Clears and drains the heat constraint and relieves coughing and panting. |
Indication | This formula is indicated for coughing and panting caused by lung heat. The symptoms are coughing, panting, and steaming heat of skin that worsens in the late afternoon, a red tongue body with a yellow coating, and a thready, rapid pulse. |
Pathogenesis | This is a pattern of heat constraint and fire retention in the lung. The heat is constrained in the lung, which causes qi to counterflow and produce coughing and panting. Lung heat steams outward to the skin, resulting in steaming heat of the skin. Different from exterior heat, retained interior heat gradually consumes yin, which increases the steaming heat in the late afternoon. When the skin is first touched, steaming heat is evident by the warmth that is initially felt. However, the heat sensation decreases over a period of time. This characteristic makes this type of steaming heat different from the steaming heat of yangming, which increases over time. A red tongue body with a yellow coating and a thready, rapid pulse are signs of consumption of yin by pathogenic heat. Therefore, the therapeutic method used is to clear and drain heat constraint, and to relieve coughing and panting. |
Application | 1. Essential pattern differentiation Xie Bai San is a commonly used formula used to treat coughing and panting caused by retained fire in the lung. This clinical pattern is marked by coughing, panting, and breathlessness, steaming heat of the skin, red tongue body with a yellow coating, and thready, rapid pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of fire retention in the lung and damage to the qi and yin: bronchitis, early stage pneumonia, and early stage rubeola in children. 3. Cautions and contraindications Do not use the formula in patients with a cough caused by wind-cold or deficiency of the lung. |
Additonal formulae | Ting Li Da Zao Xie Fei Tang (Lepidium/Descurainiae and Jujube Lung-Draining Decoction, 葶藶大棗瀉肺湯) [Source]《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 [Ingredients] Ting li zi (boiled until black and ground into cubes) 9g, da zao 12 pcs (4g) [Preparation and Administration] Add 3 sheng of water to boil da zao until 2 sheng of water remained. Remove da zao and add ting li ze and decoct it until 1 sheng of water left and take it. [Actions] Drains the lung, moves water, lowers qi, and relieves panting. [Applicable Patterns] Profuse phlegm and dampness. Symptoms include: panting, coughing, and chest fullness. |
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