What Fang Feng Tong Sheng San is for
This is one of the biggest formulas in the tradition, and its logic on the skin is about outlets. The picture is hot, angry and congested: itchy eruptions, hives or boils on a robust body, where the Heat has nowhere to go and pushes out through the surface instead. Opening every exit at once is the whole design, which is why the formula is strong and short.
The skin is hot, red and angry, with itchy raised eruptions, hives or boils, and the face may be flushed with the same heat. The lesions look congested rather than dry, and they flare when the person is hot, stressed or overheated. The tissue feels tight and full, as though pressure is building under it. This is the skin of excess rather than depletion: full, robust and running hot.
Ma Huang opens the pores so the Heat has a surface outlet, and Fang Feng, Jing Jie and Bo He release the Wind-Heat that drives the itching. Shi Gao, Huang Qin, Lian Qiao and Zhi Zi cool the Heat itself, Hua Shi drains Damp-Heat away, and Da Huang with Mang Xiao clear the interior so the pressure pushing into the skin is released from below. Dang Gui, Chuan Xiong and Bai Shao keep the Blood moving while all of this happens.
It is a short, strong course of days rather than weeks, and it is contraindicated in pregnancy and in anyone depleted, thin or dry. It is stopped once the surface settles, because the purgative action is the reason for the caution. This is not a formula for pale, dry, undernourished skin, however itchy it is, and it is not a long-term remedy for recurring hives.
Actions
- Releases the exterior and disperses Wind-Heat
- Clears Heat and drains downward
- Purges the bowel
- Moves Blood and resolves toxicity
Properties
- Taste and temperature: Predominantly bitter, pungent and salty. Bitter clears Heat, pungent releases the surface, salty softens and purges.
- Organs: Lungs, Stomach, Large Intestine, Liver
- Channels: Lung, Stomach, Large Intestine, Liver
The pattern behind it
The pattern is combined excess: Wind-Heat at the surface and Heat accumulating inside with a bowel that is not moving. When the interior is blocked, the Heat has no outlet and pushes outward to the skin. Opening the surface and the bowel together gives it two ways out, which is why the formula is used for hot eruptions in a constipated, robust person.
Composition
The herbs in Fang Feng Tong Sheng San, with their role and dose.
| Role | Herb | Dose | Properties | Why it is there |
|---|---|---|---|---|
| Fang Feng | 3 to 6 g | Slightly warm, Pungent, sweet | Dispels Wind and releases the surface, the named herb of the formula. | |
| King | Ma Huang | 3 to 6 g | Warm, Pungent, bitter | Opens the pores and releases the exterior strongly, giving the Heat a surface outlet. |
| Da Huang | 3 to 6 g | Cold, Bitter | Purges the bowel so the interior Heat has a downward outlet. | |
| Mang Xiao | 3 to 6 g | Cold, Salty, bitter | Softens and purges, working with Da Huang to clear the bowel. | |
| Jing Jie | 1.5 to 3 g | Slightly warm, Pungent | Releases the surface and vents Wind-Heat gently. | |
| Bo He | 3 to 6 g | Cool, Pungent | Disperses Wind-Heat and clears the head. | |
| Shi Gao | 6 to 12 g | Cold, Sweet, pungent | Clears strong Heat while protecting fluids. | |
| Huang Qin | 6 to 12 g | Cold, Bitter | Clears Heat from the upper body and the Lungs. | |
| Lian Qiao | 3 to 6 g | Slightly cold, Bitter | Clears Heat and resolves toxicity. | |
| Jie Geng | 6 to 12 g | Neutral, Bitter, pungent | Opens the Lung Qi so the surface and the bowel actions work together. | |
| Zhi Zi | 1.5 to 3 g | Cold, Bitter | Clears Heat from the three burners and drains it out through the urine. | |
| Hua Shi | 12 to 18 g | Cold, Sweet, bland | Drains Damp-Heat through the urine, the third outlet. | |
| Dang Gui | 3 to 6 g | Warm, Sweet, pungent | Nourishes and moves Blood, so the purging does not leave it stagnant. | |
| Chuan Xiong | 3 to 6 g | Warm, Pungent | Moves Qi and Blood, supporting the circulation of the whole formula. | |
| Bai Shao | 3 to 6 g | Slightly cold, Bitter, sour | Nourishes Blood and softens, balancing the strong action. | |
| Envoy | Bai Zhu | 1.5 to 3 g | Warm, Bitter, sweet | Supports the Spleen so the purging does not damage digestion. |
| Gan Cao | 6 to 12 g | Neutral, Sweet | Harmonises the formula and supports the middle. |
Patterns it treats
Damp-Heat
Hot, angry, itchy eruptions, hives or boils on a full, flushed skin that feels tight as though pressure is building beneath it. The interior is blocked, so the Heat has no outlet and is pushed outward to the surface instead.
How the formula is built
The formula opens three exits at once. The surface is released by Ma Huang, Fang Feng, Jing Jie and Bo He; the urine is opened by Hua Shi and Zhi Zi; the bowel is purged by Da Huang and Mang Xiao. The clearing herbs deal with the Heat itself, and the Blood-moving and middle-supporting herbs keep the attack from causing damage. That is why it can resolve a hot congested skin picture quickly, and why it must not be given to a depleted person.
Skin conditions it is used for
Where this formula appears in the skin conditions of the library.
Preparation and use
Taken as a powder in warm water, or decocted, in two divided doses.
Modifications
- If the constipation is not marked, the purgative herbs are reduced.
- If the eruption is very hot, the clearing herbs are increased.
- If the person is not robust, the formula is reduced or a milder one used.
- If the skin is dry and the person is depleted, this formula is not appropriate.
Timing
Taken in two divided doses, and stopped as soon as the bowel moves and the heat settles.
Duration
Acute use: three to seven days, and not beyond eight to ten days without reassessment.
Diet while taking it
Avoid alcohol, fried and hot spicy food; increase fluids while the bowel is being purged.
Safety
Contraindications
Contraindicated in pregnancy. Avoid in depleted, thin or dry patients, in Yin deficiency, and in anyone without excess signs. Do not use long term because of the purgative action.
Interactions
Ma Huang interacts with cardiac and blood-pressure medication and stimulants. Da Huang and Mang Xiao can affect electrolytes and interact with diuretics and digoxin. This formula requires professional supervision.
Pregnancy
Contraindicated. The formula contains Ma Huang and purgative herbs that pose significant risks in pregnancy.
Breastfeeding
Use only under professional guidance.
Children
Used only with professional supervision, and not in depleted children.
Before you use it
Recorded from the classical record and rewritten in this project's own words. Educational only: not a prescription, and Ma Huang and the purgatives make this a professional formula.
General safety references
General references for herbal hepatotoxicity and herb-drug interactions; they are not specific to this formula.
- Review article: Herbal hepatotoxicity - an update on traditional Chinese medicine preparations. Alimentary Pharmacology & Therapeutics, 2014. PMID: 24844799.
- Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs, 2009. PMID: 19719333.
- Warfarin and food, herbal or dietary supplement interactions: a systematic review. British Journal of Clinical Pharmacology, 2021. PMID: 32478963.
Selected PubMed records
Real PubMed records for the modern, non-TCM discussion of this formula. They are references, not a claim that the formula is proven for any skin condition.
- Inhibitory effect of bofutsushosan (fang feng tong sheng san) on glucose transporter 5 function in vitro.. Journal of natural medicines, 2018. PMID: 29423591.
- Japanese traditional Kampo medicine bofutsushosan improves body mass index in participants with obesity: A systematic review and meta-analysis.. PloS one, 2022. PMID: 35417488.
Origin and history
Huang Di Su Wen Xuan Ming Lun Fang (黄帝素问宣明论方) by Liu Wansu, Jin dynasty, 12th century.
Liu Wansu developed the formula in the Jin dynasty around his theory that Heat is a common cause of disease and needs an outlet. The result is one of the largest formulas in the tradition, opening the surface, the urine and the bowel at once, and it remains the reference formula for hot eruptions in a robust constipated patient.
Evidence note
No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.
Common questions
Why does a skin formula contain a purgative?
Because the interior Heat has no outlet when the bowel is blocked. Purging it gives the Heat a way down and out, which is why the formula works for hot congested eruptions.
Who should not take it?
Depleted, thin or dry patients, anyone with Yin deficiency, and pregnant women. It is for robust people with excess signs.
Is Ma Huang safe?
It is a strong herb that interacts with cardiac and blood-pressure medication, so the formula needs professional supervision.
How long is it taken?
Days rather than weeks: three to seven days typically, and not beyond eight to ten without reassessment.