Ma Xing Shi Gan Tang

What It Is

Ma Xing Shi Gan Tang (literally, Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) is a well-known herbal formula first recorded in the ancient Chinese medical text Shang Han Lun (Treatise on Cold Damage) by Zhang Zhongjing.

It is composed of four primary herbs:

• Ma Huang (Ephedra sinica) – promotes sweating, releases the exterior, and relieves wheezing.
• Xing Ren (Prunus armeniaca, Apricot Kernel) – descends rebellious Qi of the lungs and stops coughing.
• Shi Gao (Gypsum Fibrosum) – a mineral used to clear internal heat and calm fever.
• Gan Cao (Glycyrrhiza uralensis, Licorice Root) – harmonizes the formula, tonifies the spleen, and alleviates toxicity or harshness of other ingredients.

Traditionally, this formula is used to treat cough, asthma, or wheezing accompanied by fever, thirst, and labored breathing—often corresponding to respiratory infections, bronchitis, or pneumonia in modern terms.

How It Works

From a Traditional Chinese Medicine perspective, the formula’s mechanism is to release heat from the lungs while simultaneously restoring the normal downward movement of Lung Qi.

• Ma Huang opens the pores, disperses wind-cold, and facilitates the movement of Lung Qi to relieve wheezing.
• Xing Ren directs Lung Qi downward, counteracting the rebellious upward flow that causes coughing and shortness of breath.
• Shi Gao clears intense internal heat, addressing the fever and thirst that occur when an external pathogen transforms into heat in the lungs.
• Gan Cao harmonizes the actions of the other herbs and soothes irritation of the throat.

From a modern biomedical standpoint, the formula is thought to:

• Exert bronchodilatory effects (mainly from Ma Huang and Xing Ren).
• Demonstrate anti-inflammatory and antipyretic actions (primarily through Shi Gao and Gan Cao).
• Regulate immune response and reduce airway hyperreactivity.

Thus, it works by reducing airway constriction, clearing heat (inflammation), and improving breathing.

Why It’s Important

Ma Xing Shi Gan Tang holds significant importance in both classical TCM theory and modern clinical practice for several reasons:

1. Clinical Efficacy: It remains a foundational formula for treating respiratory disorders such as acute bronchitis, asthma, pneumonia, influenza, and even COVID-19–related respiratory distress in some integrative protocols (under professional supervision).
2. Balanced Therapeutic Approach: The combination of dispersing (Ma Huang), descending (Xing Ren), and cooling (Shi Gao) effects with harmonizing support (Gan Cao) makes it a balanced treatment — addressing both “excess heat” and “Qi stagnation” without overtaxing the system.
3. Historical and Educational Significance: As one of Zhang Zhongjing’s essential prescriptions, it demonstrates the core principles of formula construction in TCM — treating both root (pathogenic heat) and branch (respiratory symptoms).
4. Bridge to Modern Medicine: Research shows pharmacological parallels between the formula’s actions and modern respiratory therapeutics (e.g., ephedrine’s bronchodilatory effect, licorice’s anti-inflammatory glycyrrhizin).

Considerations

While Ma Xing Shi Gan Tang is effective, it must be used with caution and under qualified supervision, due to the potency of its ingredients and their pharmacological effects.

Contraindications:

• Unsuitable for those with Yin deficiency, absence of heat signs, or profuse sweating (as Ma Huang induces perspiration).
• Avoid in patients with hypertension, cardiac conditions, or nervous agitation, due to the stimulating nature of ephedra alkaloids.

Possible Side Effects:

• Excessive sweating, insomnia, palpitations, or dry throat if misused.
• Long-term or improper use may deplete body fluids or Qi.

Modern Regulatory Context:

• In some countries, Ma Huang (Ephedra) is restricted due to potential cardiovascular risks associated with ephedrine alkaloids. Modified versions or substitutes may be used in those contexts.

Professional Supervision:

• Proper diagnosis in TCM is crucial: the formula is intended for Lung Heat with Wheezing, not for cold-type or deficiency-type respiratory issues.