Minor Bupleurum and The Prevention of Recurrent Infections in Children - Chinese Medicine Update

Townsend Letter for Doctors and Patients,  Jan, 2002  by Bob Flaws

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In Chapter Two of the Nei Jing Su Wen (Inner Classic, Simple Questions), the "bible" of Chinese medicine, the Yellow Emperor says, "The superior doctor treats [when there is] not [yet] disease." This oft-quoted line underscores the importance prevention has traditionally played in Chinese medicine. As an extension of this and in pediatrics, inoculation against smallpox was practiced in Sichuan province as early as the Song dynasty (960-1280 CE) and was widely practiced throughout China by the Ming (1368-1644 CE), at least 100 years before its widespread use in the West. (1) However, today, prevention within Chinese medical pediatrics primarily consists of regulating the child's diet and lifestyle. Nevertheless, there is one particular Chinese herbal formula which has proven itself especially effective for prophylactic use in our xiao pang you or "little friends." That formula is Xiao Chai Hu Tang (Minor Bupleurum Decoction).

Minor Bupleurum Decoction is first found in Zhang Zhongjing's famous late Han dynasty Shan Han Lun (Treatise on Damage [Due to] Cold). In that book, the locus classicus of Chinese herbal prescriptions, Minor Bupleurum Decoction is indicated as the main formula for the treatment of a shao yang aspect disease. A shao yang disease describes a situation where an externally invading evil qi or pathogen exists half externally and half internally. This means that the evil qi is still located in the exterior aspect of the body at the same time as it has also worked its way into the interior. This is a commonly seen stage in some acute, infectious upper respiratory tract diseases. Typically, it occurs after the person has been ill for several days. Besides a cough, the patient is fatigued, may be nauseous, and definitely has lost their appetite. In addition and pathognomonically, the patient also suffers from alternating fever and chills or hot and cold. This is the classic presentation of a shao yang disease for whic h Minor Bupleurum Decoction is indicated. However, Minor Bupleurum (as it is commonly known to Chinese medical students and practitioners) is the single mast commonly prescribed Chinese herbal formula in Japan, Taiwan, and North America, and it is probably only prescribed for a shao yang disease in less than one out of 10 times it is recommended. This is because Minor Bupleurum is an extremely broad-acting harmonizing formula.

Harmonizing formulas are one of the basic 20 plus categories of Chinese medicinal formulas. Harmonizing formulas can harmonize various things. They can harmonize the defensive and constructive, as in shao yang disease. But they can also harmonize the liver and stomach, liver and spleen, spleen and stomach, and stomach and intestines. Minor Bupleurum harmonizes the liver and stomach, the liver and spleen, and the stomach and intestines, and a liver-spleen disharmony is the single most commonly seen disease mechanism in chronic complaints in both children and adults the world over. This is why Minor Bupleurum is so commonly employed all over the world. A liver-stomach disharmony is shorthand for liver depression qi stagnation which has horizontally counterflowed to attack the stomach, causing the stomach qi to become disharmonious and counterflow upward, and thus resulting in nausea, vomiting, hiccup, and/or burping and belching. A liver-spleen disharmony is shorthand for liver depression qi stagnation horizont ally counterflowing to attack the spleen, causing the spleen qi to become vacuous and weak, and thus resulting in fatigue, loss of strength, loss of appetite, possible loose stools, cold hands and feet, and easy susceptibility to external invasion. Because "the spleen is the root of phlegm engenderment," spleen vacuity is further commonly complicated by phlegm, dampness, and turbidity. A stomach and intestinal disharmony typically means that there is nausea and vomiting above at the same time as there is diarrhea below.

In Chinese pediatrics, there are a number of "statements of fact" about children's anatomy and physiology differentiating them from adults. It is a statement of fact that children's spleens (and stomachs) are weak and immature. The logical extensions of this (at least in Chinese medicine) are that they do not engender the same amounts of qi and blood as adults, are, therefore, easily invaded by evil qi, are easily affected by improper diet, and easily engender phlegm and dampness. It is also a statement of fact in Chinese pediatrics that, "The liver commonly has a surplus." This means that most children suffer from some element of liver depression qi stagnation. Liver depression is caused by unfulfilled desires, and who has more unfulfilled desires than a baby who is dependent on others for literally everything? Further, children have a "pure yang body." This means that their yin and yang are not mutually interdependent in the same way as they are in mature adults. Therefore, yin and yang do not mutually cont rol and temper each other, and yang easily flares or flames up, giving rise to internal heat. If one puts these various statements of fact and their logical extensions together, we find that children easily develop a liver-spleen disharmony, easily develop phlegm and dampness, and easily develop internal heat. These tendencies are all aggravated by faulty diet as well as iatrogenesis.