Huang Lian Tang (Coptis Decoction) huáng lián táng · 黄连汤

Safety. Huang Lian Tang comes from the Shanghan Lun and it holds its opposite in the same bowl: coptis rhizome, which is bitter and cold, together with dried ginger and cinnamon twig, which are acrid and warm. The original line is short and clinical — heat in the chest, a pathogenic factor in the stomach, pain in the abdomen, an urge to vomit. Later writers gave this shape a name, acrid opening and bitter descending, and put it at the head of a whole family of formulas that use the same trick. The formula is genuinely interesting for that reason, and it is also the one in this batch most likely to be taken as a self-diagnosis. It should not be. Pain in the abdomen with an urge to vomit is, in an emergency department, a presentation that is worked through surgically as much as medically. Bowel obstruction, appendicitis, cholecystitis, pancreatitis, perforation, bowel ischaemia, and — because inferior wall myocardial infarction and diabetic ketoacidosis both present with abdominal pain and vomiting — a cardiac and metabolic branch as well. The classical phrase heat above, cold below is a way of describing a combination of findings, not a label a person can assign to themselves, and nothing in it tells you whether the pain is obstruction. The ingredient with the most practical consequence here is coptis, because its principal alkaloid is berberine, and berberine is one of the better documented interaction risks in the whole materia medica. It inhibits cytochrome P450 3A4 and 2D6 and P-glycoprotein. Raised blood levels of tacrolimus and ciclosporin after berberine have been reported, which matters enormously for transplant recipients; warfarin, digoxin, some statins and some antidiabetic medicines appear on the same caution list. Berberine also commonly causes nausea and constipation. Its most serious and least widely known property is that it displaces bilirubin from albumin: berberine has been linked to kernicterus and is contraindicated in neonates and avoided in jaundiced infants and in glucose-6-phosphate dehydrogenase deficiency. Coptis is also not the same drug as picrorhiza, whose Chinese name carries the same character. Three more ingredients carry notes that cannot be skipped. Pinellia rhizome in its raw state is a genuine hazard — calcium oxalate raphides plus a lectin cause painful mucosal swelling that can threaten the airway, which is why only processed pinellia is used, and why the classical incompatibility list sets it against the aconite group and the tradition treats it as contraindicated in pregnancy. Ginseng is not American ginseng and not codonopsis, and it appears in both classical incompatibility lists: against Veratrum in the eighteen antagonisms, and against flying squirrel faeces in the nineteen incompatibilities. Reports of altered INR in people taking warfarin and of hypoglycaemia in people taking glucose-lowering medicine are the two interactions worth knowing. Cinnamon twig is the twig of a Cinnamomum species; cassia cinnamon contains measurable coumarin, which is why European food safety bodies set a tolerable intake for it, and long sustained intake of cassia is the exposure that concern is about. Licorice closes the list with the syndrome it always carries — sodium retention, potassium loss, raised blood pressure, and a compounding effect with digoxin and diuretics. This page is not a recommendation. No quantity, no preparation, no regimen, no claim. Transplant recipients, people taking warfarin or a direct oral anticoagulant, people on digoxin, lithium, insulin or a sulfonylurea, pregnancy and breastfeeding, children, and anyone with liver, kidney or heart disease have no room here at all. Localising abdominal pain, vomiting that will not settle, a rigid abdomen, blood in the vomit or stool, chest pain, or jaundice are emergency features.