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Forsythia 18 is derived from Bupleurum and Rehmannia Combination (Chaihu Qinggan Tang; Bupleurum Liver-Cleansing Decoction) and Schizonepeta and Forsythia Combination (Jingjie Lianqiao Tang), which are indicated for skin eruptions, middle ear infection, rhinitis, tonsillitis, acne, and other upper body infections. Forsythia 18 has applications similar to those in which modern antibiotics are used. From the traditional viewpoint, the formula dispels wind and cleans toxins. In the modern interpretation, several of the herbs in this formula have direct antibacterial activity (e.g., coptis, phellodendron, forsythia, lonicera), while some of the ingredients alleviate common symptoms, such as congestion and pain (e.g., chrysanthemum, schizonepeta, cnidium). In general, anti-infection formulas have a cold nature, but this one also has the warming herbs platycodon, schizonepeta, cnidium, siler, tang-kuei, and myrrh that help resolve local congestion of qi, moisture, and blood. Digestive problems do not arise with use of this formula (even when used regularly) because there are no high doses of the herbs that might weaken the stomach/spleen. This formula might be differentiated from those that treat wind-heat. The influence of the toxin (see explanatory notes for Lonicera 13) changes the syndrome from one of brief duration - and mostly involving congestion and heat - to one that may last longer, recur frequently, and involves a localized manifestation of the most severe symptoms (e.g., earache, painful sinus obstruction). For acute infections, consider adding Myrolea-B (White Tiger).