Drain the Middle is a faithful rendition of Pinellia Decoction to Drain the Epigastrium (Ban Xia Xie Xin Tang). It addresses a pattern of simultaneous excess and deficiency in the Middle Burner due to the improper purging of an external, or half exterior, half interior influence. This formula is a variation of Minor Bupleurum Decoction (Xiao Chai Hu Tang), in which Bupleurum has been replaced by Coptis rhizome. When an invasion has not been properly purged, it can aggravate an existing Stomach deficiency and sink deeper into the body. This will cause a clumping effect in the epigastrium and focal distention, which has a localized, focused sensation of blockage and discomfort. The person will have a sensation of fullness, but a belly that is soft to the touch. An underlying Stomach Qi deficiency allows the external influence to take hold and transform into Heat. Over time, Heat depletes vital essences, causing greater deficiency and eventually Cold. The Stomach and Spleen are no longer able to perform their functions of raising and transforming the Qi, thus the turbid Yin stagnates with Cold settling into the lower body and Heat rising to the upper body, creating a complex interaction of Hot and Cold clumping together. This formula addresses the obstruction of the Qi dynamic in the epigastrium andharmonizes the Middle Burner. To address this dichotomy, Drain the Middle combines herbs with a cold and hot nature. The formula’s chief herb, Coptis rhizome, clears Heat, drains Damp Heat in the Stomach and Intestine and dries Dampness. Its actions are supported by Chinese skullcap root to clear Heat and dry Dampness, especially lodged in the Stomach and Intestines. Licorice cured Pinellia rhizome disperses clumping and focal distention, dries Dampness, transforms Phlegm and directs rebellious Qi downward while Ginger rhizome dispels Cold, and warms the Spleen and Stomach. White Asian ginseng root and rhizome and Black jujube fruit support the Middle Burner Qi and prevent the dispersing actions of the chief herb and its deputies from injuring the normal Qi. Honey fried Chinese licorice root and rhizome tonifies the middle Qi and harmonizes the actions of the other herbs. The herbs in this formula reinforce Qi, harmonize the Stomach, descend rising Qi and disperse fullness. ORIGINS AND DEVELOPMENTShang Han Lun. It is a variation of Minor Bupleurum formula (Xiao Chai Hu Tang).
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