Ma Huang (Ephedrae herba) and Gui Zhi (Cinnamomi cassiae ramulus) can both expel Wind-Cold to treat Exterior Wind-Cold syndrome. What are the differences between their actions and characteristics? What are the cautions regarding their use?
Ma Huang and Gui Zhi can expel Wind-Cold and treat Exterior Wind-Cold syndrome. Compared with Gui Zhi, Ma Huang is stronger in inducing sweating and expelling Wind-Cold from the surface of the body. This is because Ma Huang is very pungent and warm, and its speed of movement and strength are stronger than Gui Zhi. When Wind-Cold attacks the body surface, the pores are closed by Cold, which is characteristically contracting, so the Defensive Qi is not able to spread over the surface of the body. In consequence, the patient feels chilly because the surface of the body is not warmed up by the Yang and Qi.
The blockage of Defensive Qi inside may then produce Heat and the patient may have a fever. Because Cold initially injures the Yang-Qi in the Greater Yang (Tai Yang) meridian, this stops the Qi circulating freely, and the patient feels pain and stiffness in the back of the body. Due to dysfunction of the dispersion of Lung-Qi, there are also cough and shortness of breath.
Ma Huang enters the Lung meridian, disperses the Lung-Qi, enters the Bladder meridian, activates the Defensive Qi, opens the pores, causes sweating, and expels Wind and Cold so that the Exterior can be released. This herb is considered as the strongest one for causing sweating. It is the first-line choice where Wind-Cold is severe and the patient has severe chills and fever without sweating, such as in upper respiratory tract infection, cold infections, influenza, acute bronchitis, pneumonia and asthma.
Gui Zhi can also treat Wind-Cold syndrome. Here the therapeutic result is achieved by warming the Blood, promoting Blood circulation, opening up the meridians, and activating the Yang-Qi to expel Wind and Cold. Compared with Ma Huang, Gui Zhi is not so warm and pungent, but sweet. It enters the Heart meridian primarily, and the Lung and Bladder meridians secondarily.
The warm nature of this herb can reduce Cold in the Blood. Pungency and warmth may also activate the Blood circulation and open up the meridians. The sweetness moderates the warmth and pungency so that the medicinal action may be balanced. As it enters the Lung and Bladder meridians, it can activate the Yang-Qi to eliminate Wind and Cold in the Exterior layer.
When the pathogenic Cold is not so severe, the pores are not closed so tightly, which manifests as slight sweating or a milder cold sensation and less pain in the back of the body, Gui Zhi can be used alone. It is especially useful for patients with Exterior syndromes against the background of a Yangdeficient constitution, Bi syndrome or Cold in the Blood, such as in elderly people, patients with chronic bronchitis, pulmonary emphysema, rheumatism or Raynaud’s disease. In clinical practice, Ma Huang and Gui Zhi are often used together to treat severe Wind-Cold syndrome, as they work on different aspects-for instance, the former enters the Qi level, the latter enters the Blood level; the former induces sweating and eliminates Wind-Cold by a short, quick and strong action, the latter promotes the Blood circulation, warms it, stops pain and activates the Yang-Qi in the Blood, thereby expelling Wind-Cold. When they are used together, the therapeutic effects are enhanced.
Although there are differences between Ma Huang and Gui Zhi, they both belong to quite warm and pungent herbs in the herbal group of expelling Wind-Cold. The dosage should be carefully managed. Age, constitution and the present state of health should also be considered. Generally speaking, after taking these herbs, if the patient does not sweat, the dose should be increased within the normal dosage range. If the patient becomes sweaty and the chills and fever are less severe, Ma Huang and Gui Zhi should not be used again.
Some herbs with a gentler action can be substituted, such as Jing Jie (Schizonepetae herba) and Fang Feng (Saposhnikoviae radix). If, after a while, the chills and fever return, Ma Huang and Gui Zhi should be used again but in a smaller dosage as the Wind and Cold have already been partially expelled.
Moreover, as the tendency of action of these two herbs is upward and outward, in the following conditions they should not be used or used with caution: patients suffering from acute infection of the nose and throat where there is internal Heat or Heat due to Deficiency in the body, patients suffering from hypertension which indicates a tendency to Liver-Yang rising, or women suffering from menopausal syndrome with hot flushes and night sweats, and people with a Yang constitution or with heart disease, because these herbs can increase the contraction of the cardiac muscle and increase oxygen consumption, which makes the heart overwork.
