Ma Huang Fu Zi Xi Xin Tang

Ma Huang Fu Zi Xi Xin Tang (Ephedra, Asarum, and Prepared Aconite Decoction), from the Shang Han Lun (Discussion of Cold-Induced Disorders) by Zhang Zhong-Jing.

Actions: Strengthens yang and releases the exterior.

Presentation: Shaoyin syndrome complicated with taiyang syndrome: severe aversion to cold, absence of perspiration, mild or no fever, and a deep pulse.

Cautions:

• Contraindicated in yang deficiency without an exterior condition (cold body and limbs, watery diarrhea with undigested food, deep faint fine pulse): may cause profuse sweating and yang collapse
• Contraindicated during pregnancy and nursing
• Contraindicated in heat, excess and/or dryness conditions
• Use with extreme caution: all three herbs are very warm or hot; misuse can consume yin and fluids (thirst, dry mouth/throat, insomnia, irritability)
• Ma Huang must be combined with yang tonics; with serious yang deficiency (watery diarrhea, faint fine pulse) do not use - give Si Ni Tang first, then treat the exterior

Herb–drug interactions:

• Ofloxacin-resistant fever: 7 elderly patients unresponsive to ofloxacin 300 mg/day for 3 days became afebrile (<37°C) after 7 days of the formula, with Fu Zi dose halved
• Drug-resistant Pseudomonas aeruginosa: one elderly patient given 1,200 mg/day dried extract (Ma Huang 4g, Xi Xin 3g, Fu Zi 1g) for 7 days; fever and CRP normalized; suggested as an option for fever not responding to antibiotics after 3 days, especially in the elderly

Pharmacological effects reported:

• Antiallergic: effective in a type I allergy mouse model, proposed via IL-4 inhibition; l-ephedrine identified as a major active constituent; potential for passive cutaneous anaphylaxis and allergic rhinitis
• Anti-inflammatory: in mice and rats inhibited acetic-acid vascular permeability, arachidonic acid/phorbol ester ear edema and bradykinin/histamine extravasation, apparently by preventing mediator release from mast cells and macrophages

Source: Chen JK, Chen TT. Chinese Herbal Formulas and Applications: Pharmacological Effects & Clinical Research. Art of Medicine Press, 2009, p. 132.

Cook Ma Huang in 10 cups [2,000 mL] water until reduced by 2 cups [400 mL], skim foam, add the rest and reduce to 3 cups [600 mL]; take 1 cup [200 mL] warm three times daily. Bracketed doses may be used today.