Grand is its Flower, Understated are its Applications

Introduction

In today’s blog I will explore Platycodon grandiflorus L., known in the nursery trade as balloon flower and in Chinese medicine as jiegeng (桔梗). This plant was part of some of the earliest collections going from Asia to European gardens. The root is eaten in many places in China, being prepared as part of cold dishes and fermented foods. It has become a staple in many cosmetics in China, Korea, and Japan, where the plant is native.

I’ve always appreciated jiegeng’s simplicity combined with both elegance and grace in the garden, not to mention the fact that it is very easy to grow! The remainder of the post today will be sort of a rough draft of a monograph, or at least a part of a monograph, in my upcoming translation and annotation of the mid-Qing dynasty text known as the De Pei Bencao (得配本草), or the Materia Medica of Combinations.

The original part of the text is represented below by italicized type. The remaining parts are my additions and translations noted as “annotations.” It is my hope that these annotations help the reader to better understand the original text. I have endeavored to offer specific formula and/or clinical information that will be immediately applicable in a therapeutic manner when working with our clients.

Finally, I must apologize for three things about this post, 1) I have not included a list of cited texts (if you really need to know, ask in the comments about any specific text and I will provide the citation), 2) herbs are only represented using pinyin while formulas are presented both in English and Chinese characters (again, if you are unsure of an herb name, ask in the comments and I will provide further information), and 3) all measurements are also represented as pinyin. For those not familiar with the weight measurements used in Chinese medicine (liang, qian, & fen), from the Song through the Qing dynasties, which covers this article, measurements were as follows; 1 liang = 37.3 g, 1 qian = 3.7 g, and 1 fen = 0.37 g.

桔梗 jiegeng

Acrid, bitter, level. Enters the hand tai-yin channel, as well as the qi aspect. Moves [through] the exterior and expresses [through] the orifices. Opens and lifts the qi and blood. Can carry all medicinals to the surface. Used to disperse all constrained binds. Treats phlegm congestion, hasty panting, nasal congestion, lung abscess, dry cough, red eyes, throat impediment with painful swallowing, toothache with mouth sores, piercing pain in the chest and diaphragm, and abdominal pain with rumbling intestines.

Combine with zhizi and dahuang to treat red, swollen, painful eyes.

Annotation: This combination is found in Zhang (1624) in his formula Peony Clear the Liver Powder (芍藥清肝散). He states, “To treat excessive ‘gum’ in the eyes with blurred or dim vision, [a feeling of] tightness and dryness with aversion to light, red veins throughout the eyes, and the viscera and bowels are closed and bound.”

Formula: baizhu, chuanxiong, fangfeng, qianghuo, jiegeng, huashi, shigao, mangxiao (each 3 fen), huangqin, bohe, jingjie, qianhu, zhi gancao, shaoyao (each 2.5 fen), chaihu, shanzhi, zhimu (each 2 fen), and dahuang (4 fen). Take hot between meals.

Combine with niubangzi and dahuang to treat epidemic toxin.

Annotation: One way to look at this combination is to first examine Zhang Zhongjing’s Platycodon Decoction (桔梗湯), which is a simple combination of jiegeng and gancao in a ratio of 1:2 by weight. In the Essentials from the Golden Cabinet (金貴要略), we can see that this formula was originally for “cough with a sensation of fullness in the chest, cold shivers, a rapid pulse, dry throat without thirst, with occasional coughing of turbid, stinking, spittle with pus and the appearance of rice gruel due to lung abscess.” This is wind-heat with internal congestion constraining the lung qi.

Wang (1602) modifies Zhang Zhongjing’s formula by adding niubangzi, dahuang, and mangxiao to treat “epidemic toxin with swelling in the head [region]” (i.e., face, throat, etc.). Zhang (1624) says that jiegeng acts as a conducting herb for dahuang, causing it to go upward. Epidemic toxin as a term is not frequently used and carries the meaning of “seasonal epidemic,” which is the section (Seasonal Epidemic) in Wang (1602) where the first occurrence of the term is used. This text appears to have drawn from Wang’s formula but dropped the mangxiao. Seasonal epidemic is a type of heat disease that first attacks the upper burner and can cause significant congestion of qi and fluids in the lung viscera and channel. The addition of niubangzi assists jiegeng and gancao to free the throat while also gently resolving the exterior. Jiegeng conducts dahuang upward where its bitter flavor and cold nature will clear heat and drain congested fluids in the lung and throat (i.e., upper burner).

Combine with zhike to disinhibit the chest and diaphragm.

Annotation: In this formula, jiegeng is acrid and dissipates, diffusing the lung and disinhibiting the diaphragm; zhiqiao is bitter and warm, regulating qi and loosening the center. Jiegeng upbears while zhiqiao downbears to unblock the qi dynamic, loosen the chest, and disinhibit the diaphragm.

Zhu Gong (1108) states, “Treats cold damage glomus qi with a sensation of fullness in the chest and sense of hopelessness.”

In the Song dynasty Formulary of the Pharmacy Service for Benefiting the People in the Taiping Era Formulas (太平惠民和劑局方) this combination is used in the formula Ginseng Vanquish Toxin Powder (人參敗毒散) to “treat damage by cold seasonal qi with headache, stiff neck, vigorous heat and aversion to cold, vexation with body aches, cold congestion with cough, nasal congestion with deep hoarse [voice], retching with heat [effusion] (fever) and [aversion to] cold, [this formula] treats all these symptoms equally.

Formula: chaihu (remove sprout), gancao, jiegeng, renshen (remove neck), chuanxiong, fuling (remove skin), zhiqiao (remove pulp, wheat bran mix-fry), qianhu (remove sprout, wash), qianghuo (remove sprout), duhuo (remove sprout)

Directions: Combine 30 liang of each herb and [grind to a] coarse powder. Each dose is 2 qian with one bowl of water, add a little of each sheng jiang and bohe, decoct down to 70%, remove dregs and take any time. If there is more cold, administer hot, if there is more heat, administer warm.

Qin (1714) discusses a formula known as Bitter Orange and Platycodon Decoction (枳桔湯), which consists of only these two herbs, stating, “Zhongjing used Bitter Orange and Atractylodes Decoction (枳朮湯) to treat glomus due to spleen vacuity with food stagnation and uses all types of Drain the Heart Decoction (瀉心湯) to treat glomus due to cold damage heat disease. Today Bitter Orange and Platycodon Decoction is used to sweep the chest before qi [binds to form] glomus, as well as binding in the chest, rib-side, and limb.

Shi Jinmo states, “Combine with zisugeng, treats any [condition where] the qi dynamic is impeded, manifesting with symptoms such as oppression in the chest and feeling uncomfortable, qi reversal, etc.”

When these two medicinals are used together, one [bears] upward and one [bears] downward. They open the chest and normalize qi, disperse the intestine, eliminate fullness, and “boost brightness.”

Sovereign to gancao to treat shao-yin painful swallowing, and for lung abscess with coughing and spitting of pus add to glutinous rice congee.

Annotation: Qin (1714) states, “In the original text (i.e., Treaties on Cold Damage) it says, shao-yin disease, after 2–3 days there is throat pain, Licorice Decoction (甘草湯) can be used; if the patient does not recover, use Platycodon Decoction (桔梗湯). Accordingly, gancao drains heart fire but if the condition does not heal after using this formula, this is fire pathogen bound in the lung, it cannot be resolved at the exterior, therefore jiegeng [is used to] open the lung and effuse qi while at the same time gancao drains latent fire from the chest. The reason this [approach is used] is the awareness that the desired treatment is to clear the bound pathogen from within the lung, this requires both opening of the lung [qi] and clearing lung [heat]. When these two herbs are used together, the pathogen from within the lung begins to exist. This combination is similar to the way that Drain the White Powder (瀉白散) is constructed where fangfeng is used to resolve lung wind and shigao is used to drain lung fire.

Add Cool the Diaphragm Powder then it won’t have such a drastic downbearing action.

Annotation: Cool the Diaphragm Powder (涼膈散) originates in the Tai Ping Imperial Grace Pharmacy Formulary, first published in 1078 and updated several times with the final edition published in 1148. This is the first government sponsored patent formula text published in China and was part of a major public health movement during the Song dynasty. The text states, “treats adult and children with heat accumulation in the viscera and bowels, vexation and agitation with excessive thirst, heat in the head with dizziness, burnt (i.e., very dry and cracked) lips, dry throat, tongue swollen and throat blocked, eyes red and nose bleeding, jaw and cheek bound and hard,* ulcerations in the mouth and on the tongue, phlegm repletion inhibited,** thick and sticky nasal mucus and saliva, disquieted sleep, delirious speech and manic ravings, dry and inhibited stomach and intestines, constipation, and/or everything congested by wind. This formula is equally appropriate to give [for any of these symptoms].

Formula:  chuan dahuang, poxiao (mangxiao), zhi gancao (each 20 liang), shanzhizi, bohe ye, (remove stem), huangqin (each 10 liang) lianqiao (2.5 jin)

Directions:  Grind all the herbs to a course powder. For every 2 qian use 1 small cup of water, to it, add 7 bamboo leaves and a small amount of honey. Decoct to 70% and remove the dregs. Take warm after meals. For children use 1/2 qian and add or subtract according to the child’s age. This formula will achieve a disinhibiting and downbearing action.

When considering this formula with the addition of jiegeng we see that the author states that it lessens the downbearing action due to the upbearing nature of jiegeng. However, we also have an affliction of heat rising and, although it is causing constipation, the majority of the symptoms are in the upper body. Furthermore, there is a phlegm congestion and possibly cough, and jiegeng is bitter and drains heat from the upper burner, including the tai-yin and shao-yin, and treats phlegm congestion and throat impediment. Therefore, the addition of jiegeng to this formula makes sense, especially, to treat the symptoms in the upper burner.

*NOTE: Lock jaw or similar.

**NOTE: This is somewhat unusual and offers no specifics about what the replete phlegm is inhibiting. The term “phlegm repletion” is used 15 other times in the text. In other cases, they are mostly associated with cough and congestion of phlegm in the lungs. The term is also used several times to present congested phlegm in the diaphragm, although this seems like an unlikely connection considering the over-all pattern being described for this formula.

Use with blood supplementing medicinals to clear and rectify the throat.

Annotation: Chen (1174) discusses a pattern known as heart vacuity cold, originally discussed by Sun Simiao. The person with this pattern is fearful, has palpitations, and an emotionally depressed constitution. They also have pain in the heart and abdomen area, difficulty using speech, a sensation of coldness in the heart area with absentmindedness, bloody nose, yellow facial complexion, vexation and oppression, warmth in the five palms with thirst, throat pain, and talks to themselves. The tongue is stiff. In pregnant women, there is nausea and vomiting, with dizziness, fatigued limbs with little impetus to move them, and no desire to eat. The formula focuses on supplementing qi and nourishing blood, however nourishing blood is the primary focus, consisting of Four Ingredients Decoction (四物湯) with the addition of jiegeng. When the heart is vacuous and cold, blood cannot be engendered in the body. When blood is vacuous, qi cannot be engendered.

Use with medicinals to treat dysentery to open constraint of the lung qi at the large intestine.

Annotation: Shen (1773) states, “[For dysentery with] abdominal pain that won’t stop, this is lung pathogen constrained in the large intestine. Jiegeng and zisuzi are sovereigns in a formula, baishao, gancao, chenpi, muxiang, and danggui are assistants. If the patient has aversion to cold, add gan jiang, if the person has aversion to heat, add huanglian, if there is vacuity weakness use Fortify the Middle Decoction (建中湯). Another formula is equal parts zhiqiao and huanglian, huaihua (1 liang) used to mix-fry with the zhiqiao and huanglian. Disgard the huaihua, use the other two herbs and decoct with ruxiang and moyao (each 8 fen). This is a marvelous formula to treat abdominal pain.”

Use with medicinals to treat cough to dissipate constraint of due to fire pathogens within the lung.

Annotation: Jiegeng is commonly used for constraint in the chest. Yang (1833) states, “[Jiegeng] governs the treatment of lung heat qi with hasty breathing, cough, or counterflow…and pain due to stagnant qi in the chest and diaphragm.” Zhu (1358) says, “Dry cough is difficult to treat. This pattern is related to fire constraint leading to phlegm constraint fire pathogen in the center. Use ku jiegeng to open it.” An example of this is found in Wu (1798), “Hand tai-yin summerheat warmth with cough but no phlegm, a distinctive hoarse sound when coughing. The governing formula is Clear the Network Vessels Powder (清絡散) with the addition of gancao, jiegeng, tian xingren, maidong, and zhimu. There is cough but no phlegm, if there is no cough [the pathogen] is not evident, the cough is distinctly hoarse, the sound of the lung is clear and resounding, chronic cough leads to hoarseness, fire tends to be [the cause] of this pathogenesis, not dampness. Use Clear the Network Vessels Powder,* it clears the formless heat from within the lung channel, add gancao (1 qian) and jiegeng (2 qian) to open and lift the lung, tian xingren (2 qian) to disinhibit the lung without damaging the qi, maidong (3 qian) and zhimu (3 qian) to protect the lung yin and control fire.”

*NOTE: This formula is for the treatment of summerheat damage to the lung channel and qi aspect. It doesn’t address fire or cough. The addition of the other herbs clearly shows that combining herbs such as xingren for cough and maidong and zhimu for lung fire along with jiegeng change the formula significantly, demonstrating the main principle in this passage.

Clear the Network Vessels Powder (acrid, cool, aromatic method)

fresh bohe leaf (2 qian), fresh jingyinhua (2 qian), watermelon rind (2 qian), fresh biandouhua (1 branch), sigua peel (2 qian), fresh heart of zhuye (2 qian).

Scrape off the outer skin, soak in rice water, gently stir-fry. This herb is not appropriate to use in formulas that are specifically for downbearing. Prohibited for use in any cases where qi is floating upwards or blood disease with fire flaming.

If you’ve made it this far, then you love this stuff as much as I do and I applaud your willingness to join me for this exploration of one of China’s most useful and also beautiful plants.

Stay in touch,
Thomas Avery Garran

Edited by Rachael Witt

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