Minor Bupleurum & The Prevention of Recurrent Infections in Children

Keywords: Minor Bupleurum, recurrent infections in children, Chinese medicine, Chinese medical pediatrics

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 terms 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), a least one hundred 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 Zhong-jing’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 which Minor Bupleurum Decoction is indicated. However, Minor Bupleurum (as it is commonly known to Chinese medical students and practitioners) is the single most 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 horizontally 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 control 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.

In Chinese medicine, the spleen and stomach are the two main viscera in charge of digestion. Because infant’s spleens (and stomachs) are inherently weak and immature, they cannot digest foods as easily and completely as adults. This means that, if infants are fed either the wrong food or simply too much food, this may cause food stagnation in their stomachs. If food stagnates in their stomachs, the stomach qi loses its harmony and commonly counterflows upward, causing abdominal distention, nausea, vomiting, loss of appetite, and burping-belching. This stagnant food impedes the free flow of qi, and so either causes or aggravates liver depression qi stagnation. Because of this qi stagnation and the baby’s pure yang body, this depression may transform heat in the liver-gallbladder and stomach. Because heat is yang in nature and, therefore, tends to rise, it floats upward to accumulate in the heart (causing crying, fussiness, and disturbed sleep), in the lungs (causing various respiratory tract inflammations), and in the head (causing oral thrush, gingivitis, conjunctivitis, and/or otitis). “Wrong food” in terms of infants means the too early introduction of solid foods in general, certain specific foods, such as sugar, cheese, nut butters, and wheat and corn products, and uncooked, chilled foods (cooking is predigestion in Chinese medicine). Too much food can mean overfeeding even mother’s milk. If hard-to-digest foods or simply over-feeding jams up the baby’s qi mechanism, it does not matter how supposedly nutritious the foods are. They will still cause harm to the baby.

Because so many of us were/are fed incorrectly as infants, a liver-stomach/liver-spleen disharmony is the single most common chronic disease mechanism in human beings. In addition, iatrogenesis in the modern world also contributes to this situation. Antibiotics are described as attacking and draining, cold, heat-clearing medicines in Chinese medicine. While they clear heat and resolve toxins, they can also damage the spleen and stomach and especially in infants and young children whose spleen and stomach are inherently weak and immature. Therefore, inappropriate or excessive use of antibiotics easily aggravates spleen-stomach vacuity weakness. In China, this is now referred to as “post-antibiotic spleen vacuity syndrome.” We see this in clinical practice all the time. The child develops an earache (due to inappropriate diet). They are treated with antibiotics. The antibiotics temporarily clear the inflammation. But, because they damage the spleen, they aggravate the development of phlegm and damage the defensive qi, thus making the child all the more susceptible to invasion by external evils. The earache comes back, more antibiotics are given, the earache goes away temporarily, but then it comes back yet again. This cycle repeats itself over and over again until either the child “outgrows” the situation or tubes are surgically implanted.

However, even when the child supposedly outgrows their earaches, it is the experience of many Chinese medical practitioners that many modern children simply develop a different site of disease depending on their diets, lifestyles, environment, and constitutions. Thus earaches often metamorphose into strep throat/tonsillitis in toddlers, strep throat may metamorphose into bronchitis in kindergarteners and grade-schoolers, and bronchitis may metamorphose into a lifelong tendency to allergies of various sorts and even asthma. In fact, many Chinese medical pediatricians such as myself see a definite evolution from neonatal colic (food stagnation) to earaches to tonsillitis to bronchitis to allergies, asthma, and even autoimmune diseases, all centered around the disease mechanism of liver-spleen disharmony initiated as infants. Happily, it is exactly this situation which Minor Bupleurum addresses so effectively.

Within this formula, Chai Hu courses the liver and resolves depression as well as clears heat from the liver-gallbladder. Dang Shen and mix-fried Gan Cao fortify the spleen and supplement the qi. Huang Qin clears heat from the lungs, liver-gallbladder, stomach, and intestines. Ban Xia and Sheng Jiang harmonize the stomach qi and downbear upward counterflow. They also transform phlegm, eliminate dampness, and help regulate and rectify the qi. Da Zao supplements the spleen and nourishes the heart. Thus it helps Dang Shen fortify and supplement the spleen qi at the same time as it constructs and, thus, quiets the spirit. In addition, Gan Cao, Da Zao, and Sheng Jiang harmonize all the other ingredients in this formula, insuring that no ingredient causes any harm or damage to the spleen and stomach. Therefore, taken as a whole, this formula courses the liver and rectifies the qi, fortifies the spleen and supports the righteous, harmonizes the stomach and downbears counterflow, clears heat, transform phlegm, and eliminates dampness.

While Minor Bupleurum is prescribed to both infants and adults alike, it is particularly good for prophylactic use in children. It is the most common formula I prescribe whenever I hear that a child has recurrent infections of one sort or another. These may be earaches, strep throat, or bronchitis. During the acute episode, one must usually modify Minor Bupleurum with the addition of various other Chinese medicinals specific to the infection or inflammation. For instance, Blue Poppy Herbs’ Bupleurum & Angelica for earaches and Cold Quell for colds and flus are both modifications of Minor Bupleurum. However, once the infection or inflammation has been dealt with, long-term administration of Minor Bupleurum often prevents recurrences in such children. In that case, I often prescribe this 1,800 year old formula from October to April for one or two years. Minor Bupleurum Decoction is available from a number of Chinese herbal suppliers as an easily administered powdered extract.

However, for Minor Bupleurum to get its full preventive effect, the child’s diet must be adjusted to eliminate foods which damage the spleen and aggravate phlegm and heat. In Chinese medicine, this is called a “clear, bland” diet. For more information on the clear, bland diet in general, see my The Tao of Healthy Eating, and, for more information on the clear, bland diet and pediatrics, see my Keeping Your Child Healthy with Chinese Medicine, both available from Blue Poppy Press. In addition, this formula should be prescribed by a professional practitioner of Chinese medicine. Since each person has their unique constitution and health needs, no one formula fits everyone. Often this formula must be modified with individually determined additions and subtractions. Nevertheless, when it comes to the Yellow Emperor’s advice to treat disease before it arises, Minor Bupleurum often fills that bill, and especially in infants and children.

^[1]Temple, Robert, The Genius of China, 3,000 Years of Science, Discovery and Invention, Simon & Schuster Inc., NY, 1986, p. 135-137