Huang Lian Tang (黄连汤) — Coptis Decoction

On this page

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

Overview

Huang Lian Tang — the “Coptis Decoction” — is from Zhang Zhongjing’s Shang Han Lun. It treats the difficult clinical picture where Heat is lodged in the upper burner / Stomach while Cold is lodged in the lower burner / Intestines, producing simultaneous Heat symptoms (epigastric burning, nausea^[12], bitter taste) and Cold symptoms (abdominal pain that responds to warmth, loose or cold-pattern diarrhoea). The formula is a relative of Ban Xia Xie Xin Tang with Gui Zhi added to better warm the channels and circulate Yang in the chest.

I prescribe Huang Lian Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Huang Lian Tang is prescribed for Heat in the upper burner with Cold in the lower:

• Epigastric pain, burning, nausea or vomiting (upper Heat)
• Abdominal pain that improves with warmth and pressure (lower Cold)
• Loose stools or cold-pattern diarrhoea
• Bitter taste, dry mouth above; cool sensation in lower abdomen
• Possibly belching or hiccups
• Tongue — mixed yellow-and-white coat, often greasy
• Pulse — wiry above, deep below

Key herbs

1. Huang Lian (Rz. Coptidis, 3-10g) — chief; clears Stomach Heat; stops vomiting and burning
2. Gan Jiang (dried ginger, 3-10g) — warms the middle and lower burners; counters cold-pattern diarrhoea
3. Gui Zhi (Ram. Cinnamomi, 3-10g) — warms the channels; circulates Yang in the chest
4. Ban Xia (Rz. Pinelliae Preparatum, 5-10g) — harmonises the Stomach; descends rebellious Qi; stops vomiting
5. Ren Shen (Rx. Ginseng, 2-10g), Zhi Gan Cao (Rx. Glycyrrhizae, 2-10g), Da Zao (Fr. jujube, 3-6g) — tonify and harmonise the middle

Formula actions

1. Clears Heat from the Stomach
2. Warms Cold in the Intestines
3. Harmonises the middle burner
4. Descends rebellious Qi; stops vomiting

Conditions treated

1. Mixed Cold-Heat IBS[5] with vomiting/burning above and loose stool with cold pain below — see IBS
2. GORD with intestinal cold pattern
3. Chronic gastritis with upper-Heat and lower-Cold
4. Bile reflux gastritis with mixed pattern
5. Functional dyspepsia with mixed Cold-Heat
6. Chemotherapy nausea with cold-pattern diarrhoea

Cautions

Not appropriate for pure Heat patterns or pure Cold patterns — pattern identification is essential.

Acute severe upper abdominal pain, haematemesis or melaena require urgent 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

[5] Liu Q, Shi Z, Zhang T, Jiang T, Luo X, Su X, Yang Y, Wei W. Efficacy and Safety of Chinese Herbal Medicine Xiao Yao San in Functional Gastrointestinal Disorders: A meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. Front Pharmacol. 2022 Jan 19;12:821802. https://doi.org/10.3389/fphar.2021.821802. PMID: 35126152.

[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.

What is Huang Lian Tang used for?

Huang Lian Tang (Coptis Decoction) is the principal Chinese herbal formula for the dyspepsia pattern of cold below with heat above, characterised by epigastric discomfort, mild nausea, mouth ulcers, bitter taste in the mouth alongside cold-pattern abdominal cramping or loose stools. It's particularly useful in stress-pattern functional dyspepsia where the patient has both heat features (acid reflux, mouth ulcers, irritability) and cold features (cold drinks worsen, prefers warm food).

How does Huang Lian work in Chinese medicine?

Huang Lian (Coptis chinensis rhizome) is the principal heat-clearing and Damp-Heat-resolving herb in Chinese medicine, with potent action on the Stomach, Heart and Large Intestine. It treats Damp-Heat dysentery, mouth ulcers, gastric ulcers with bleeding, and Heart-fire-disturbed insomnia. The bitter alkaloid berberine is the principal active constituent, with documented antibacterial, anti-inflammatory and gut-microbiome-modulating effects in modern research.

Can Huang Lian Tang treat H pylori or peptic ulcer?

Huang Lian Tang has been used historically and in modern Chinese practice as adjunctive treatment alongside conventional H pylori eradication therapy. Berberine from Huang Lian has documented anti-H pylori activity in vitro and in animal models. The formula reduces inflammation and supports gastric mucosal healing alongside the conventional antibiotic triple therapy. Combination treatment often produces better symptom relief and lower recurrence than antibiotics alone.

Is Huang Lian Tang safe in pregnancy?

Use with caution in pregnancy. Huang Lian is a cold-natured herb that can theoretically aggravate cold-pattern presentations and is not first-line in pregnancy. For pregnancy-related dyspepsia, gentler formulas like Zuo Jin Wan or modified Ban Xia Hou Po Tang are usually more appropriate. Always seek qualified herbalist advice.

How does Huang Lian Tang compare to PPI medication?

Huang Lian Tang and PPI medication work through different mechanisms: PPIs (omeprazole, lansoprazole) reduce acid secretion directly; Huang Lian Tang addresses the underlying TCM heat pattern and supports mucosal healing. Many patients use both together initially, then taper the PPI under their GP's supervision as the herbal treatment takes effect. For PPI-dependent reflux, the herbal approach is often more sustainable long-term.