Chai Hu (Bupleurum chinense) is an essential herb in traditional Asian medicine that has been used for centuries for its therapeutic properties. The herb has a long history dating back to the Han dynasty (206 BC–220 AD), and its use has been documented in various medical texts throughout the ages.
In traditional Chinese medicine and Kampo (traditional Chinese medicine as practiced in Japan), Chai Hu is classified as a cool herb with bitter and acrid properties that act on the jueyin and shaoyang domains. It is commonly used to address conditions related to liver qi stagnation, such as menstrual disorders, digestive issues, and emotional imbalances.
As can be guessed, Chai Hu is a key herb in the Chai Hu Tang formula family, which are used to address a variety of conditions related to liver zang disorders. These formulas typically combine Chai Hu with other herbs such as Huang Qin (Scutellaria), Huang Lian (Coptis), and Zhi Ban Xia (Pinellia). To give a sense of the frequency of Chai Hu formula inclusion, Kan Herb Company produces over 40 formulae which contain Chai Hu!
According to the Shennong Bencao Jing, Chai Hu:
“addresses the heart and abdomen; gets rid of bound qi in the intestines and stomach, of accumulations and gatherings of food and drink, and of evil qi of cold and heat; and pushes out the old to usher in the new. Consumed over a long period of time, it lightens the body, brightens the eyes, and boosts essence. Grows in river valleys.”
The Kampo formula Sho-saiko-to, also known as Xiao Chai Hu Tang in Chinese medicine, is an oft-prescribed staple of the Japanese medical system.
Sho-saiko-to is used in Kampo medicine to address generally chronic, liver zang-related conditions. The formula also contains herbs such as Ginseng, Scutellaria, and Licorice, which work together to enhance the beneficial effects of Chai Hu.
In TCM, the concept of Dui Yao (對藥), or herb pairing, is an important aspect of herbal medicine. Dui Yao involves combining two or more herbs in a formula to enhance their therapeutic properties and minimize any potential adverse effects. For example, Chai Hu is often paired with Huang Qin for conditions related to shaoyang disorders, as the two herbs have complementary natures that work together to soothe the liver and reduce inflammation.
In classical Chinese medicine, dui yao is a fundamental concept that dates back to the Shang Han Lun and the Jin Gui Yao Lue, two ancient texts (uniting as the Shang Han Za Bing Lun) that provide guidelines for addressing health syndromes using herbal medicine. This source material describes the principles of herb pairing and provide numerous examples of effective dui yao combinations for various sets of symptoms and signs (辯證). For example, the combination of Bai Shao (white peony root) and Chuan Xiong (Szechuan lovage root) is a classic dui yao for menstrual disorders, as Bai Shao nourishes the blood while Chuan Xiong promotes blood circulation.
One well-known dui yao combination in Kampo is the pairing of Keishi-ka-shakuyaku-to (Gui Zhi Jia Shao Yao Tang in Chinese medicine), which contains cinnamon twig and peony root, and Hange-koboku-to (Ban Xia Hou Po Tang in Chinese medicine), which contains pinellia rhizome and magnolia bark.
Another example of dui yao in Kampo medicine is the pairing of Rikkunshito (Liu Jun Zi Tang in Chinese medicine), which contains ginseng, licorice, and other herbs, and Daikenchuto (Da Chai Hu Tang in Chinese medicine), which contains Bupleurum and other herbs. This combination is used to address gastrointestinal disorders such as constipation, bloating, and nausea. Furthermore, the most prescribed Kampo formula shakuyaku-kanzo-to (Shao Yao Gan Cao Tang) consists of only the dui yao Bai Shao and Gan Cao in equal proportion. This formula is used extensively by Japanese physicians for alleviating muscle spasm and chronic lumbar pain.
In Kampo, dui yao is also an important concept that is used to optimize the therapeutic effects of herbal formulas. Kampo medicine was developed in Japan based on the principles of Chinese medicine, and it incorporates many of the same herbs and formulas. In fact, the term kampo literally translates to (Chinese) medicine from the Han dynasty. However, Kampo medicine has also developed its own unique formulas and dui yao combinations over time.
Since we’ve covered some interesting minutiae regarding Chai Hu and associated formulas, let’s dive into a concise history and promulgation of Chinese medicine in Japan.
Kampo (漢方薬) is a distinct, parallel development of generally Shanghan Lun-based medicine brought to Japan by way of Korea during the 5th century CE. There were two main schools of Kampo: the Goseiha and Kohoha. Goseiha was heavily influenced by Jin-Yuan dynasty medicine. The theory and practice of Li Dongyuan and Zhu Danxi feature heavily in this form of Kampo. Goseiha’s development was attributed to Sanki Tashiro (1465-1537) who visited China during his lifetime, and who, upon returning from his 12-year Chinese medical saturation, propounded the Jin-Yuan style of medicine. The Goseiha school was influential for multiple centuries in Japan, eventually giving way to an even more classical approach, the Kohoha style of medicine.
The Kohoha school relied exclusively on the six conformation theory penetrating the Shang Han Lun (taiyang, shaoyang, yangming, taiyin, shaoyin, jueyin syndromes, in various combinations). Kohoha style minimized theoretical elaboration, focusing instead on direct application of herbal therapeutics based on differentiation of signs and symptoms–the method of Zhang Zhongjing, and a form of Jing Fang style diagnosis (经方).
Jing Fang, and by extension Kampo, is an extremely effective system for addressing health holistically. The notions of tizhi (體質) constitution, as it relates to symptom-sign-formula complexes, allows for powerful application of herbal agents. This constitutes a truly practice- and evidenced-based approach which may simplify and streamline even the most disparate and complex cases.
Chai Hu has been featured today due to its ubiquity within the herbal zeitgeist, especially as it relates to shaoyang presentations. The shaoyang conformation (both half-in/half-out) is such a common presentation within the clinic, with signs and symptoms that can bewilder Western medicine.
Gaining fluency and command of some of the classic principles of East Asian medicine connects us all to the multitude of lineages and myriad practitioners who are now, and who have come and gone. With precise diagnosis and appropriate formulation, a skilled practitioner can be a positive force in the direction of integrative health.