So, here we have a situation of fluids stuck in the body. And this is a formula traditionally used when there is exterior cold as well as interior fluid stagnation.
For exterior cold: 麻黄、桂枝 to induce perspiration and hence relieve the exterior
For interior fluid stagnation: 麻黄、桂枝 to induce diuresis and hence treat fluid stagnation; 细辛、干姜、五味子 get rid of fluids in the chest; 半夏 dries up fluids in the stomach (inhibit secretion of gastric juices).
What if there are no exterior signs?
It’s fine really, since, 麻黄 and 桂枝 can be used to facilitate diuresis too. But it’s important that the person’s constitution can handle 麻黄. Otherwise, I’ll think of 五苓散 as a replacement for 麻、桂.
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Experiment done in 1982 by a Mr. Wang shows that it’s not just Ephedra and Pinella – both of which which have ephedrine as a beta agonist that dilate bronchial smooth muscle – that treats panting. Other herbs in Xiao Qing Long Decoction also help treat panting.
Common strategies include blocking histamine, ACh or barium chloride.