long dan xie gan tang 龍膽瀉肝湯

Name of Formula: long dan xie gan tang (Yi Zong Jin Jian )
Uses:
(1). Traditional uses: for overactive sympathetic nervous system, bacterial infection of urinary tract and/or vagina area, jaundice due to hepatitis, middle ear infection, gall bladder stones, conjunctivitis, migraine due to overactive sympathetic nervous
system, overactive thyroid.
(2) New uses:
a. For Mondor disease
Directions:
With high liver fire or liver/gall bladder with damp heat, take 3 times a day, 9 grams each time.
b.  For shingles (herpes zoster), acute psoriasis, acute skin allergies with liver yang ascending  or liver/gall bladder with damp heat, take 3 times a day, 9 grams each time.
Caution: Do not use this formula if the diagnosis is blood deficiency and wind heat  (血 虛 風 燥 ).
Composition:
long dan cao 6 g, huang qin 9 g, shan zhi zi 9 g, ze xie 12 g,
mu tong 9 g, che qian zi 9 g, chai hu 6 g, gan cao 6 g, sheng di 9 g.
Boil with water. One prescription a day, made into two servings.
Stop taking when symptoms subside. Do not take it for a long time.
Warning: This formula can be toxic to the kidneys because of the herb mu tong. There are different varieties of mu tong in the market. Before the Qing dynasty, however, it was not toxic because mu tong was derived from either the plant of Akebia guinata or the plant Akebia lobata.  Today, ninety five percent of mu tong  used in China is from the stem of Aristolochia debilis, called guan mu tong (關木通), a toxic plant usually grown in the northeastern provinces of China, formally called Manchuria. Only rarely in a few localities in China, is mu tong obtained from Akebia guinata or Akebia lobata being used. Many cases of kidney failure have been reported in the China from taking this manufactured formula. Today in China, all manufactured formulae that contain guan mu tong (aristolochia debilis) are being banned because of the toxicity to the kidneys.
If you use this formula in raw herb form, make sure you are not using guan mu tong. Use chuan chuan mu tong or huai tong, or bai mu tong tong instead.
Some western countries have banned all types of mu tong totally. Check with your government agencies for updated regulations.
Manufactured formulae that contain guan mu tong are being banned in China because of the toxicity to the kidneys.
Besides long dan xie gan tang, xin yi san, xiao feng san, ba zheng san, dang gui si ni tang , dao chi san all contain mu tong. Make sure they do not contain guan mu tong which is toxic.
龍膽瀉肝湯（醫宗金鑒）

臨床應有 ﹕肝陽上亢症狀之高血壓﹐属肝膽实火之癫狂﹐急性結膜炎﹐急性中耳炎﹐鼻前庭及外耳道之癤﹐急性膽囊炎﹐急性肝炎﹐自律神經失調症﹐黴菌或細菌感染帶下﹐腹股溝淋巴結炎﹐膀胱炎﹐尿道炎﹐急性睪丸炎﹐急性前列腺炎﹐過敏性皮膚炎﹐带狀疱疹﹐骨盤內炎症﹐膣炎﹐陰部疼痛﹐子宮內膜炎等症。
處方：
龍膽草 6 g, 黄芩 9 g, 山栀子 9 g, 澤瀉 12 g,
木通 9 g, 車前子 9 g, 柴胡 6 g, 甘草 6 g, 生地 9 g.
水煎服。每日一剤，分二次服。中病則止。不宜過剤。
注意﹕木通有幾種。現在市場上賣的 95% 是關木通, 屬于馬兜鈴科﹐對腎臟有毒。凡含有關木通的成藥將被禁賣。
如用木通﹐不可用關木通。須用川木通﹐或淮通﹐或白木通。
龍膽瀉肝湯之外，其他如辛夷散﹐消風散﹐八正散﹐當 歸四逆湯﹐導赤散等藥方，也都含有木通 。如含關木通者﹐不可用。
(by Joe Hing kwok Chu)