Bai Hu Jia Cang Zhu Tang (白虎加苍术汤) — White Tiger plus Atractylodes Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions

Overview

Bai Hu Jia Cang Zhu Tang — “White Tiger plus Atractylodes Decoction” — is from Zhu Gong’s Song-dynasty Huo Ren Shu. It adds Cang Zhu to Bai Hu Tang to address intense Heat that is combined with prominent Damp: high fever with heavy-bodied feeling, joint pain that is hot but also heavy and immovable, sticky tongue coat. Plain Bai Hu Tang clears the Heat but doesn’t address the Damp; Cang Zhu dries Damp while the cold herbs continue to clear Heat. The pattern is common in humid summer febrile illness and in inflammatory joint disease with prominent swelling.

I prescribe Bai Hu Jia Cang Zhu Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Bai Hu Jia Cang Zhu Tang is prescribed for intense Heat combined with Damp:

• High fever, sweating, thirst (Bai Hu signs)
• Heavy-bodied feeling, fatigue^[9], foggy thinking (Damp signs)
• Hot painful joints with prominent swelling
• Possible foul-smelling diarrhoea or nausea^[12]
• Tongue — red body with yellow-greasy coat
• Pulse — surging, slippery, rapid

Key herbs

1. Shi Gao (Gypsum Fibrosum, 30–60g) — chief; clears intense Qi-level Heat
2. Zhi Mu (Rx. Anemarrhenae, 6–15g) — nourishes Yin; clears Heat
3. Geng Mi (rice, 9–15g) — protects Stomach Qi
4. Zhi Gan Cao (Rx. Glycyrrhizae Preparata, 3–6g) — harmonises
5. Cang Zhu (Rz. Atractylodis, 6–9g) — dries Damp; expels Wind-Damp from the channels

Formula actions

1. Clears intense Heat at the Qi level
2. Dries and resolves Damp
3. Addresses joint pain with combined Heat and Damp

Conditions treated

1. Acute rheumatoid arthritis[14] flare with hot, swollen, heavy joints
2. Acute gout flare with prominent oedema
3. Damp-Heat summer febrile illness
4. Acute Damp-Heat dysentery with high fever
5. Severe acute eczema flare with Damp-Heat pattern
6. Septic arthritis recovery with residual Damp-Heat

Cautions

Strictly for the Damp-Heat pattern with full Bai Hu signs — not for cold or deficient patterns.

Acute joint infection or systemic febrile illness requires medical assessment.

Always consult a qualified Chinese herbalist registered with the RCHM.

Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide.

References

[9] Wang YY, Li XX, Liu JP, Luo H, Ma LX, Alraek T. Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complement Ther Med. 2014 Aug;22(4):826-33. https://doi.org/10.1016/j.ctim.2014.06.004. PMID: 25146086.

[12] Zhai X, He Q, Chen M, Yu L, Tong C, Chen Y, et al. Pinellia ternata-containing traditional Chinese medicine combined with 5-HT3RAs for chemotherapy-induced nausea and vomiting: A PRISMA-compliant systematic review and meta-analysis of 22 RCTs. Phytomedicine. 2023 Jul;115:154823. https://doi.org/10.1016/j.phymed.2023.154823. PMID: 37099981.

[14] Han R, Ren HC, Zhou S, Gu S, Gu YY, Sze DM, Chen MH. Conventional disease-modifying anti-rheumatic drugs combined with Chinese Herbal Medicines for rheumatoid arthritis: A systematic review and meta-analysis. J Tradit Complement Med. 2022 Jan 26;12(5):437-446. https://doi.org/10.1016/j.jtcme.2022.01.005. PMID: 36081815.