Tong Guan San通关散
Open the Gate Powder
Ingredients2 herbs
Indications
The excess closed pattern— sudden collapse from turbid influences, fright or phlegm, in which qi is blocked rather than exhausted. The patient is unresponsive with the jaw clenched and the fists gripped, and the constitution is not depleted.
Clinical Manifestations
- Sudden collapse with the jaw clamped shut
- Fainting from fright or turbid influences
- Phlegm collapse with a blocked throat and no speech
- Distinguishing an excess closed pattern from a collapse pattern
Health Categories
Modern Applications
Common adjustments
- A sneeze is produced and the patient begins to rouse — the closed pattern is confirmed and treatment continues with the appropriate pill — Su He Xiang Wan for cold closure, the cool-opening group for heat closure
- No sneeze at all — classically a poor sign suggesting the qi cannot respond; the assessment shifts toward a collapse pattern and toward urgent medical care
- Cold signs dominate — pale face, cold limbs, white coating — the follow-on treatment is warm opening with Su He Xiang Wan
- Heat signs dominate — flushed face, fever, yellow coating — the follow-on treatment is cool opening with An Gong Niu Huang Wan, Zi Xue or Zhi Bao Dan according to whether heat, wind or phlegm leads
Contraindications
Contraindicated in the collapse pattern— cold sweat, an open slack mouth, limp hands, incontinence, a faint pulse — where provoking a sneeze wastes what qi is left; telling closure from collapse is the decision that precedes any use of this powder. Contraindicated in pregnancy. For nasal insufflation only: never swallowed, never decocted, and never given by any other route. is irritant and toxic if ingested and Xi Xin is dose-restricted, so only a minute amount is used. Avoid in anyone with a bleeding tendency, recent head or facial injury, nasal surgery, or raised intracranial pressure, where forceful sneezing is itself a hazard. Sudden collapse requires emergency medical assessment; this powder does not replace it.
For licensed practitioners’ reference only — not a self-treatment guide.
Pregnancy
Contraindicated in pregnancy. is a classical abortifacient, Xi Xin is avoided in pregnancy, and the forceful repeated sneezing the powder is designed to provoke raises intra-abdominal pressure in a way that is itself unwise in pregnancy. Avoid while breastfeeding. A collapse in a pregnant patient is an obstetric emergency and is managed medically.
References
Source Dan Xi Xin Fa Fu Yu 《丹溪心法附余》 · Ming
- Classical source (public domain) — 《丹溪心法附余》, Ming dynasty.
2. Scheid, Bensky, Ellis & Barolet. Chinese Herbal Medicine: Formulas & Strategies, 2nd ed. — composition cross-checked; listed with the warm-opening formulas.
3. 《方剂学》（全国中医药行业高等教育规划教材）— pattern analysis cross-checked; editions differ in listing it as a principal or an appended formula.
4. Pharmacopoeial monographs on 细辛 (dose restriction) and 皂角 (irritancy, toxicity on ingestion).
Professional reference notice. Entries are scholarly references for licensed TCM practitioners and students — not medical advice, and not a recommendation to self-prescribe. Chinese herbal formulas should be used under the guidance of a qualified practitioner. Content is an original editorial compilation by Cura x Cura, cross-checked against the cited references.