Michael Tierra AHG, L.AC., O.M.D.One of the most frequently prescribed classes of drugs are glucocorticoid hormones. This includes various forms of cortisone including prednisone which are used for a wide variety of autoimmune, inflammatory, rheumatic, skin, elevated serum cholesterol, chronic and recalcitrant diseases. Typical side effects from these drugs include facial and body edema, palpitations, flushing, itchiness, tendency towards fatigue, mood swings, buffalo hump, night sweats, thin skin and vein fragility.

Chinese Herbal Formulas and appropriate non-Chinese herbal formulas may be administered both to eventually supplant the use of the prescribed herbal formula in place of the steroid medication as well as to alleviate the associated adverse reactions on patients who for various reasons may need to rely on the use of these drugs for a prolonged period of time.

Dependent upon their appropriate presentation, various formulas may be used. These include in order of recurrence:

1. Poria Five Herb Combination (Wu Ling San)
2. Bupleurum and Poria Combination (Chai Ling Tang)
3. Bupleurum and Cinnamon Combination (Chai Hu Gui Zhi Tang)
4. Persica and Rhubarb Combination (Dao Ho Cheng Chi Tang)
5. Major Bupleurum Combination (Da Chai Hu Tang)
6. Bupleurum, Cinnamon and Ginger Combination (Chai Hu Gui Zhi, Gan Jaing Tang)
7. Bupleurum and Peony Combination (Jia Wei Xiao Yao San)
8. Minor Bupleurum Combination (Xiao Chai Hu Tang)
9. Dang Gui and Peony Combination (Dang Gui Shao Yao San)
10. Pill of Cinnamon and Poria Combination (Gui Zhi Fu Ling Wan) which is effective for fluid retention and various bleeding disorders because it also promotes blood circulation.
11. Bupleurum and Dragon Bone combination (Chai Hu Lung Gu Mu Li Tang)
12. Bupleurum and Schizonepeta Combination (Shi Wei Bai Du Tang)

(All below are measured in grams and are based on Japanese Kanpo Dosage, to achieve Chinese dosage, double the indicated amounts and constitutes a daily dose. Of course any or all of these are more easily taken in concentrated dried extract from various sources.)

Poria Five Herb Combination (Wu Ling San)

Polyporus 4.5, Poria 4.5, Alisma 6.0, White Atractylodes 4.5, Cinnamon twigs 3.0

This formula is diuretic and removes stagnant fluids from the stomach, increases urine flow, relieves edema and at the same time because it assists intracellular fluids, it relieves thirst. It is useful for vomiting and diarrhea caused by the common cold, acute gastroenteritis, diabetes, seasickness, indigestion, toxemia during pregnancy, hypersalivation, nephritis, cardiac edema, hydrocele, uremia, migraine, recurrent headaches, trigeminal neuralgia, vital conjunctivitis, dacrocystitis, nyctalopia, blisters, and warts.

Bupleurum and Poria Combination (Chai Ling Tang)

Bupleurum 5.0, pinellia 4.0, scute 2.5, ginseng 2.5, jujube date 2.5, fresh ginger 4.0, licorice 2.0, cinnamon twig 2.5, polyporus 2.5, white atractylodes 2.5, poria 2.5, alisma 2.5

This harmonizing formula is a combination of both Minor Bupleurum and Poria Five Herb Formula. It clears stagnant water both from all areas of the body and is especially is effective for clearing heat and tonifying deficiencies. It has a wide range of uses including the common cold, heatstroke, acute gastroenteritis, pyelitis, nephritis, edema and liver and gallbladder disorders.

Bupleurum and Cinnamon Combination (Chai Hu Gui Zhi Tang)

Bupleurum 5.0, Pinellia 4.0, Licorice 1.5, Jujube date 2.0, Cinnamon twigs, 2.5, scutellaria 2.0, ginseng 2.0, peony 2.5, ginger 1.0

The most versatile of all herbal formulas. It is used for a wide range of acute and chronic conditions ranging from the common cold, gastrointestinal problems, arthritis, nervous exhaustion, intercostals neuralgia, headache, insomnia, gynecological disorders, hysteria, epilepsy and cardiac disorders.

Persica and Rhubarb combination (Da Ho Cheng Chi Tang)Persica seed 5.0, rhubarb 3.0, cinnamon twigs 4.0, mirabilitum 2.0, licorice 1.5

This formula is for constipation with stagnant blood polyuria, general febrile condition, chills in the waist and feet, etc.

Major Bupleurum Combination (Da Chai Hu Tang)

Bupleurum 6.0, scutellaria 3.0, Pinellia 3.0, ginger 4.0, tangerine citrus peel 2.0, white peony 3.0, rhubarb root 1.0, jujube date 3.0.

For impaired liver and gallbladder function, hypertension, ulcers, constipation, diabetes and other disorders.Bupleurum, Cinnamon and Ginger Combination (Chai Hu Gui Zhi, Gan Jiang Tang)

Bupleurum 6.0, Cinnamon twigs 3.0, Trichosanthes 3.0, scutellaria 3.0, oyster shell 3.0, ginger 2.0, licorice 2.0

It has a wide range of uses from the common cold, gastrointestinal, insomnia, palpitations, liver and gall bladder diseases but especially with upper respiratory problems.

Bupleurum and Peony Combination (Jia Wei Xiao Yao San)

Dang Gui 3.0, white peony 3.0, gardenia 2.0, white atractylodes 3.0, poria 3.0, mint 1.0, bupleurum 3.0, moutan peony 2.0, ginger 1.0, licorice 2.0

This formula is useful for most gynecological problems including chronic endometritis, leucorrhea, hyperkeratosis of the palms, leukoderma and Basedow’s disease, especially associated with moodiness and depression.

Minor Bupleurum Combination (Xiao Chai Hu Tang)

Bupleurum 7.0, Scutellaria 3.0, Pinellia 5.0, Ginseng 3.0, Jujube dates 3.0, licorice 2.0, Ginger 4.0

A formula with wide application for both acute and chronic conditions inflammation and phlegm with Qi deficiency. It is used for common cold with lingering fever, acute and chronic bronchitis, pleuritis, pneumonia, liver and gallbladder diseases including hepatitis and gallstones, gastric diseases, middle ear infections, mastitis, neck stiffness, puerperal fever, chills and fever caused by uterine inflammation, stuttering, epilepsy, impotence, neurosis, alopecia, mental instability in children and to generally improve one’s health.

Dang Gui Shao Yao San

Dang Gui 3.0, white peony 4.0, poria 4.0, atractylodes 4.0, ligusticum 3.0, alisma 4.0

This formula tonifies blood, treats gynecological disorders caused by blood and qi deficiency with dampness. These may include habitual abortion, edema, cystitis, lumbago, postpartum weakness, chronic nephritis, vascular diseases.

Pill of Cinnamon and Poria Combination (Gui Zhi Fu Ling Wan)

cinnamon twigs 4.0, poria 4.0, persica seeds 4.0, white peony root 4.0, moutan peony 4.0

This formula removes stagnant water, improves blood circulation and is useful for a wide variety of conditions including most gynecological conditions, skin diseases such as eczema, urticaria and dermatitis, nervousness, eye conditions such as recurring styes, keratitis, enlarged prostate, hypertension, neuralgia and arthritic conditions

Bupleurum and Dragon Bone combination (Chai Hu Lung Gu Mu Li Tang)

Bupleurum 5.0, poria 3.0, pinellia 4.0, rhubarb 1.0, cinnamon twigs 3.0, scutellaria 2.5, jujube dates 2.5, ginseng 2.5, ginger 2.5, oyster shell 2.5, dragon bone 2.5This is a sedative formula useful for insomnia, irritability, melancholy, depression, fearfulness, mania, with tendencies toward fatigue edema and constipation.

Bupleurum and Schizonepeta Combination (Shi Wei Bai Du Tang)

Bupleurum 3.0, raw ginger 1.0, ledebouriella 2.0, du huo angelica 2.0, poria 2.0, platycodon 3.0, schizonepeta 1.0, ligusticum 3.0, licorice 1.0, wild cherry bark 3.0.This formula is detoxifying and is specifically effective for a wide range of skin diseases, including carbuncles, boils, mastitis, dermatitis, urticaria, eczema, acne, warts, allergic opthalmia, nasal suppuration, middle and external ear infections. It is even more effective when one adds coix 4 gms to the basic formula. In severe cases of weeping eczema, Coix can also be ground into a fine powder and dusted directly onto the skin. Of course, it can also be cooked with cereals and soups.

Other formulas mentioned below:

Angelica and Loranthes Combination (Du Huo Ji Shen Tang)

Chinese dosages of Du huo angelica 6-9 gms, large leaf gentian (Qin Jiao) 3-6 gms, Ledebouriella 3-6 gms, asarum 1-3 gms, loranthes 6-9 gms, eucommia 3-6 gms, achryanthes 3-6 gms, cinnamon bark 1-3 gms, dang gui angelica 3-6 gms, ligusticum 3-6 gms, prepared rehmannia 6-9 gms, white peony 3-6 gms, ginseng 3-6 gms, poria 9-12 grm, licorice 3-6 gms.

Simmered in 4 cups of water slowly down to two. Dosage: two cups daily.For lower back and joint pains, acute and chronic arthritis.

Pueraria, Coptis and Scute Combination (Ge Gen Huang Qin Huang Lian Tang)

Chinese dosages: pueraria 10-15 gms, scutellaria 6-9 gms, coptis 3-6 gms, honey baked licorice 3-6 gms.

This formula is detoxifying and clears exterior pathogenic factors and eliminates internal heat from the stomach and intestines. It is useful for diarrhea, dysentery and acute colitis.

Case Histories

1. Man, age 47, diagnosed with chronic active hepatitis. His major complaints were severe fatigue, liver with lower back and joint pains. He had a strong physique, good diet, ruddy complexion and his liver was slightly palpable. He had been taking prednisone for 7 months during which he developed edema, moon face and palpitations.

He was given Minor Bupleurum formula to be taken before meals together with Cinnamon and Poria combination to be taken after meals. Both were given in dried extract form, about a teaspoon of each twice daily.After two months, he was able to get off the prednisone and after four months the edema, moon face and palpitations subsided.

2. Woman, age 43 diagnosed with rheumatoid arthritis from her teenage yeas. She had been taking steroids for about a year and a half. After three months she developed the characteristic edema, palpitations and was also developing various signs of ruptured veins close to the surface of the skin. She was given Du Huo Angelica and Loranthes Combination (Du Huo Ji Sheng Tang) with the addition of 4 gms of prepared aconite (Fu Zi) to relieve the chronic arthritic condition and pains. This was Prepared in decoction and taken as a tea, one cup twice daily before meals. In addition was given Bupleurum and Cinnamon Combination as a powdered extract, a level teaspoon twice daily after meals. During the next five months under the supervision of her doctor, she gradually tapered off the cortisone and within a couple of months after, he symptoms of moon face and edema subsided. After a year she continues to use the herbs with periodic day and weeklong breaks and the rheumatic arthritic pains have been significantly reduced in severity.

3. Man, age 57 diagnosed with advanced liver cirrhosis. He had symptoms of severe fatigue, exhaustion, swollen abdomen, joint pains and poor appetite. He was given steroids to relieve inflammatory symptoms and pain and had been on them for 7 months. He developed the characteristic moon face and generalized edema associated as a side effect of the drug.4. Young woman, age 26 with colitis disease, symptoms of acute lower abdominal pain, blood in the stool, paleness, fatigue and coldness. She was given steroids to relieve the pain and control the diarrhea and bleeding. This helped initially but gradually the dose needed to be increased to continue providing relief. After taking these for 6 months she developed edema, moon-face and palpitations. She was given Bupleurum and Cinnamon Combination in dried extract, one teaspoon dissolved in a cup of hot water taken twice daily after meals. In addition, she was given Pueraria, Coptis and Scutellaria Combination also in granules to be taken with warm chamomile tea with lemon after meals. She was guided by her doctor to withdraw from the steroid medication over a period of 4 months while taking the herbs. She continued with the herbs and was able to achieve increasingly prolonged periods of relief from the colitis symptoms.

5. Young girl, age 5 years with weeping eczema since infancy. She was periodically given steroid crèmes to relieve her symptoms but as soon as these were sopped the symptoms would recur. To help regulate her immune system she was given She was given Cinnamon and Poria Combination in the form of dried extract powder mixed with honey to form a paste. A teaspoon of this was taken twice daily before meals. In addition she was given Bupleurum and Schizonepeta Combination with Coix as a powdered dry extract mixed with honey or put directly into capsules to be swallowed with warm water after meals. This case began to show improvement after taking the herbs for a week. As in most cases described above patients are guided to limit the intake of refined carbohydrates and to primarily eat simply, whole grains, beans, cooked vegetables, meat, chick or fish, etc. Dramatic improvement continued over the next six months after which the formulas were reduced to be taken only three times per week.

The time required to relieve the adverse effects of the steroids ranged from three months to a year. The time required for complete discontinuation was of course dependent on the amount prescribed but for most patients averaged from six to eight months.

Bupleurum falcatum (Chai Hu) is an herb that is widely used in Japanese Chinese Medicine, called Kanpo and somewhat less so in TCM herbal medicine. The reasons are based on the heavy reliance on the 2^nd century classic Shang Han Lun as a source for Kanpo formulas by the Japanese. Characteristically Bupleurum formulas are considered as harmonizing treating opposing symptoms such as excess and deficiency, hot and cold, chronic and acute simultaneously. Because these, considered the most problematical, are the most common types of diseases that many see in practice, harmonizing formulas containing bupleurum represent the most commonly prescribed class of herbal formula.

Bupleurum is rich in a particular type of saikosapnin that closely resemble the structure of sterols. Therefore bupleurum is a potent anti-inflammatory agent that is used to relieve fevers, inflammation, depression, stagnant liver qi and to raise the yang Qi. This latter effect is attributed to bupleurum’s effect on the adrenal gland. Because of this ability to raise yang qi, a percentage of patients who take bupleurum formulas may experience uncharacteristic irritability and anger. If this occurs, one should discontinue the use of the formula containing bupleurum for three days and then gradually resume with a significantly lower dose.

Bupleurum’s specific effect in promoting greater emotional stability by regulating stagnant liver qi is probably because of its ability to stimulate the elimination of backed-up stress hormones. Bupleurum is also effective in bringing a high fever down to normal and is commonly prescribed for children and pregnant women for common cold, influenza and malaria. Bupleurum is also very effective for all form of acute and chronic hepatitis. It has been reported to stimulate bile secretion and to have liver protective functions.

Bupleurum ToxicitySaikosides of bupleurum are powerful hemolytic agents which in high prolonged doses, can increase the destruction of red blood cells. Large doses of Bupleurum have showed symptoms of gastrointestinal irritation, abdominal distension, loss of appetite, constipation and occasion facial and somatic edema. This is all similar to adverse reaction steroid reactions. The LD 50 in mice is 47 g/kg taken orally, 1.9 g/kg injected subcutaneously, 112 mg/kg interperitoneally injected and 70 mg/kg intravenously.

The recommended dosage of bupleurum is generally low between 3 to 9 grams but usually around 6 grams per day. This is well within the safe dose margin.

Conclusion

Chinese and other formulas taken concurrently with steroid medication will require a longer period to manifest positive effects on the primary symptoms. However, it is somewhat of a novel idea in practice to combine the use of herbs first to alleviate the adverse reactions of steroids and then dependent on the chonicity of the case, help a patient withdraw from steroids and use herbal formulas, known to be far safer with few adverse side effects to alleviate and control symptoms.