Chapter 2 泻下剂 Purgative formulas for interior excess syndrome
1. 寒下剂 Purgative formulas with Cold herbs
大承气汤 Da Cheng Qi Tang
From Shang Han Lun
Ingredients:
Da Huang (Radix and Rhizoma Rhei) 12g (add near end)
Mang Xiao (Mirabilitum) 6g (dissolve in hot decoction)
Zhi Shi (Fructus Immaturus Citri Aurantii) 24g
Hou Po (Cortex Magnoliae Officinalis) 12g
Actions: Purges heat accumulation powerfully.
Indications: Yangming heat injured the fluids (Yang Ming Fu Organs syndrome): Severe constipation with gas, abdominal distension and pain that refuse to be palpated, red tongue with dry yellow or dry black coat, deep forceful pulse. May have tidal fever, delirious speech, palms and soles sweating.
Once diarrhea has been induced this formula should be stopped.
小承气汤Xiao Cheng Qi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Hou Po (cortex magnoliae officinalis)…6g
Zhi Shi (fructus immaturus citri aurantii)…6-9g
Actions: moderately purges heat accumulation
Indications: Constipation, dry hard stool, abdominal distension, fullness and pain that does NOT increase with pressure, dry yellow tongue coating, slippery rapid pulse.
调胃承气汤Tiao Wei Cheng Qi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Mang Xiao (mirabilitum)…9-12g
Gan Cao (radix glycyrrhizae uralensis)…6g
Actions: mildly purges Heat accumulation
Indications: mild constipation without distension and abdominal fullness, irritability, nosebleed, swollen gums and throat, subcutaneous bleeding. Slippery rapid pulse.
增液承气汤Zeng Ye Cheng Qi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Mang Xiao (mirabilitum)…9-12g
Xuan Shen (radix scrophulariae ningpoensis)…30g
Mai Men Dong (tuber ophiopogonis japonici)…24g
Sheng Di Huang (radix rehmanniae glutinosae)…24g
Actions: Nourishes Yin, increases fluid, drains heat and unblocks bowels.
Indications: Yang brightness organ-stage disorders with Yin deficiency, Severe constipation. Dry red cracked tongue, Thin weak pulse.
桃核承气汤 Tao He Cheng Qi Tang
Shang han lun
Ingredients:
Tao Ren (semen persicae)…12-15g
Da Huang (radix & rhizoma rhei)…12g
Gui Zhi (ramulus cinnamomi cassiae)…6g
Mang Xiao (mirabilitum)…6g [add to strained decoction]
Zhi Gan Cao (honey fried radix glycyrrhizae)…6g
Actions: drains Heat, breaks up Blood Stasis
Indications: acute low abdominal pain, incontinence, night fevers, delirious speech, irritability, restlessness, thirst, or manic behavior, dysmenorrhea, amenorrhea. Deep full or choppy pulse.
2. 温下剂 Purgative formulas with warm herbs
大黄附子汤Da Huang Fu Zi Tang
Fu Zi (radix lateralis aconite carmichaeli praeparata)…9g
Da Huang (radix et rhizome rhei)…9g
Xi Xin (herba asari cum radice)…3g
Actions: Warm interior and disperse cold, unblocks bowels and stop pain.
Indications: abdominal pain, constipation, hypochondriac pain, chills, cold extremities, White greasy tongue coat, Submerged tight wiry pulse.
温脾汤Wen Pi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Fu Zi (radix lateralis aconite carmichaeli praeparata)…9g
Ren Shen (radix ginseng)…6g
Gan Jiang (rhizome zingiberis officinalis)…6g
Gan Cao (radix glycyrrhizae uralensis)…6g
Actions: Warm & tonifies spleen Yang, purges cold
Indications: constipation, abdominal pain, cold extremities, white tongue coating, deep wiry pulse.
三物备急丸 San Wu Bei Ji Wan
Three Substance Pill for Emergencies
Ingredients:
Ba Dou (Semen Croton Tiglii) 0.1-0.3g. -harshly purges, expels cold
Gan Jiang (Rhizoma Zingiberis Officinalis, Dried Ginger Rhizome, Ginger) 10g. -expels cold, revives spleen yang
Da Huang (Radix et Rhizoma Rhei, Rhubarb Root and Rhizome) 9g. -cleanses stomach and intestines, cools other herbs in formula
Actions: harshly purge cold accumulations.
Indications: Sudden epigastric and abdominal pain, constipation, abdominal distention, severe pain, rough uneven breathing, cyanotic complexion.
3. Formulas that moisten intestine
麻子仁丸(脾约丸) Ma Zi Ren Wan
From Shang Han Lun
Ingredients:
Huo Ma Ren (semen cannabis sativae)…20g
Xing Ren (semen pruni armeniacae)…10g
Shao Yao (radix paeoniae)…9g
Da Huang (radix et rhizome rhei)…12g
Zhi Shi (fructus immaturus citri aurantii)…9g
Hou Po (cortex magnoliae officinalis)…9g
Actions: moisten intestines, drain Heat, moves Qi, unblocks bowels
Indications: heat induced dryness in the stomach, constipation with hard stool that is difficult to pass, abdominal distension, frequent urination, red with dry yellow coat tongue, submerged rapid or floating choppy pulse.
济川煎Ji Chuan Jian
From Jing yue quan shu
Ingredients:
Rou Cong Rong (herba cistanches)…6-9g
Dang Gui (radix angelicae sinensis)…9-15g
Niu Xi (radix achyranthis bidentatae)…6g
Ze Xie (rhizome alismatis orientalis)…4.5g
Zhi Ke [Qiao] (fructus citri seu ponciri)…3g
Sheng Ma (rhizome cimicifugae)…1.5-3g
Actions: warm Kidney, moisten intestines, unblocks bowels
Indications: constipation, copious clear urine, low back soreness or pain, cold back, fatigue, low libido, pale lustrous face, Pale tongue, deep thin pulse.
五仁丸 Wu Ren Wan
Ingredients:
Xing Ren (Prunus armeniaca/apricot kernel) 15g - lubricates intestines, promotes downward flow of Qi
Tao Ren (Prunus persica/peach seed) 15g - lubricates intestines, removes stagnation
Bai Zi Ren (Biota orientalis/arborvitae seed) 9g - calms mind, tonifies blood, lubricates intestines
Yu Li Ren (Prunus japonica/bush cherry seed) 5g- lubricates intestines, encourages bowel movements
Song Zi Ren (Pinus tabulaeformis/pine nut seed) 5g - lubricates intestines
Chen Pi (Citrus reticulata/citrus peel) 20g - lubricates intestines, prevents stagnation
Actions: Moistens the Intestines, Unblocks the Bowels
Indications: Deficiency of fluids in the intestines presenting with constipation, dry stool or difficult bowel movements, dry tongue with thin coating, thin and soggy pulse.
4. Formulas that both attack and tonify
黄龙汤Huang Long Tang
Ingredients:
Da Huang (Radix and Rhizoma Rhei)…9g
Mang Xiao (Mirabilitum)…9g (dissolve in hot decoction)
Zhi Shi (Fructus Immaturus Citri Aurantii)…g
Hou Po (Cortex Magnoliae Officinalis)…6g
Ren Shen (Radix Ginseng)…6g
Dang Gui (radix angelicae sinensis)…9g
Jie Geng (Radis Platycodi Grandiflori) 3g
Sheng Jiang (Roasted) (Rhizoma Zingiberis Officinalis, Roasted Fresh Ginger) - 3 pieces.
Da Zao (Fructus Ziziphi Jujubae, Chinese Date, Jujube) - 2 pieces
Gan Cao (Radix Glycyrrhizae Uralensis, Licorice Root) - 3g.
Actions: Clear heat, unblock bowels and tonify Qi and blood
Indications: Constipation or watery diarrhea, abdominal pain that increse with pressure. Fever and thirsty, fatigue, shortness of breath. Dry yellow tongue coating and weak pulse.
5. Formulas that drive out excess water
十枣汤 Shi Zao Tang
Ingredients:
Gan Sui kan-sui root 甘遂
Da Ji euphorbia root 大戟
Yuan Hua genkwa flower 芫花
Da Zao (Fructus Ziziphi Jujubae) 大枣10 pieces
Actions: Drive out thin mucus
Indications: Cough with pain in the chest and hypochondria area, or edema. Shortness of breath, Hard focal distention in the epigastrium, Dry vomiting, headache, vertigo, White slippery tongue coating, Wiry pulse.
大承气汤 Da Cheng Qi Tang
From Shang Han Lun
Ingredients:
Da Huang (Radix and Rhizoma Rhei) 12g (add near end)
Mang Xiao (Mirabilitum) 6g (dissolve in hot decoction)
Zhi Shi (Fructus Immaturus Citri Aurantii) 24g
Hou Po (Cortex Magnoliae Officinalis) 12g
Actions: Purges heat accumulation powerfully.
Indications: Yangming heat injured the fluids (Yang Ming Fu Organs syndrome): Severe constipation with gas, abdominal distension and pain that refuse to be palpated, red tongue with dry yellow or dry black coat, deep forceful pulse. May have tidal fever, delirious speech, palms and soles sweating.
Once diarrhea has been induced this formula should be stopped.
小承气汤Xiao Cheng Qi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Hou Po (cortex magnoliae officinalis)…6g
Zhi Shi (fructus immaturus citri aurantii)…6-9g
Actions: moderately purges heat accumulation
Indications: Constipation, dry hard stool, abdominal distension, fullness and pain that does NOT increase with pressure, dry yellow tongue coating, slippery rapid pulse.
调胃承气汤Tiao Wei Cheng Qi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Mang Xiao (mirabilitum)…9-12g
Gan Cao (radix glycyrrhizae uralensis)…6g
Actions: mildly purges Heat accumulation
Indications: mild constipation without distension and abdominal fullness, irritability, nosebleed, swollen gums and throat, subcutaneous bleeding. Slippery rapid pulse.
增液承气汤Zeng Ye Cheng Qi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Mang Xiao (mirabilitum)…9-12g
Xuan Shen (radix scrophulariae ningpoensis)…30g
Mai Men Dong (tuber ophiopogonis japonici)…24g
Sheng Di Huang (radix rehmanniae glutinosae)…24g
Actions: Nourishes Yin, increases fluid, drains heat and unblocks bowels.
Indications: Yang brightness organ-stage disorders with Yin deficiency, Severe constipation. Dry red cracked tongue, Thin weak pulse.
桃核承气汤 Tao He Cheng Qi Tang
Shang han lun
Ingredients:
Tao Ren (semen persicae)…12-15g
Da Huang (radix & rhizoma rhei)…12g
Gui Zhi (ramulus cinnamomi cassiae)…6g
Mang Xiao (mirabilitum)…6g [add to strained decoction]
Zhi Gan Cao (honey fried radix glycyrrhizae)…6g
Actions: drains Heat, breaks up Blood Stasis
Indications: acute low abdominal pain, incontinence, night fevers, delirious speech, irritability, restlessness, thirst, or manic behavior, dysmenorrhea, amenorrhea. Deep full or choppy pulse.
2. 温下剂 Purgative formulas with warm herbs
大黄附子汤Da Huang Fu Zi Tang
Fu Zi (radix lateralis aconite carmichaeli praeparata)…9g
Da Huang (radix et rhizome rhei)…9g
Xi Xin (herba asari cum radice)…3g
Actions: Warm interior and disperse cold, unblocks bowels and stop pain.
Indications: abdominal pain, constipation, hypochondriac pain, chills, cold extremities, White greasy tongue coat, Submerged tight wiry pulse.
温脾汤Wen Pi Tang
Ingredients:
Da Huang (radix et rhizome rhei)…12g
Fu Zi (radix lateralis aconite carmichaeli praeparata)…9g
Ren Shen (radix ginseng)…6g
Gan Jiang (rhizome zingiberis officinalis)…6g
Gan Cao (radix glycyrrhizae uralensis)…6g
Actions: Warm & tonifies spleen Yang, purges cold
Indications: constipation, abdominal pain, cold extremities, white tongue coating, deep wiry pulse.
三物备急丸 San Wu Bei Ji Wan
Three Substance Pill for Emergencies
Ingredients:
Ba Dou (Semen Croton Tiglii) 0.1-0.3g. -harshly purges, expels cold
Gan Jiang (Rhizoma Zingiberis Officinalis, Dried Ginger Rhizome, Ginger) 10g. -expels cold, revives spleen yang
Da Huang (Radix et Rhizoma Rhei, Rhubarb Root and Rhizome) 9g. -cleanses stomach and intestines, cools other herbs in formula
Actions: harshly purge cold accumulations.
Indications: Sudden epigastric and abdominal pain, constipation, abdominal distention, severe pain, rough uneven breathing, cyanotic complexion.
3. Formulas that moisten intestine
麻子仁丸(脾约丸) Ma Zi Ren Wan
From Shang Han Lun
Ingredients:
Huo Ma Ren (semen cannabis sativae)…20g
Xing Ren (semen pruni armeniacae)…10g
Shao Yao (radix paeoniae)…9g
Da Huang (radix et rhizome rhei)…12g
Zhi Shi (fructus immaturus citri aurantii)…9g
Hou Po (cortex magnoliae officinalis)…9g
Actions: moisten intestines, drain Heat, moves Qi, unblocks bowels
Indications: heat induced dryness in the stomach, constipation with hard stool that is difficult to pass, abdominal distension, frequent urination, red with dry yellow coat tongue, submerged rapid or floating choppy pulse.
济川煎Ji Chuan Jian
From Jing yue quan shu
Ingredients:
Rou Cong Rong (herba cistanches)…6-9g
Dang Gui (radix angelicae sinensis)…9-15g
Niu Xi (radix achyranthis bidentatae)…6g
Ze Xie (rhizome alismatis orientalis)…4.5g
Zhi Ke [Qiao] (fructus citri seu ponciri)…3g
Sheng Ma (rhizome cimicifugae)…1.5-3g
Actions: warm Kidney, moisten intestines, unblocks bowels
Indications: constipation, copious clear urine, low back soreness or pain, cold back, fatigue, low libido, pale lustrous face, Pale tongue, deep thin pulse.
五仁丸 Wu Ren Wan
Ingredients:
Xing Ren (Prunus armeniaca/apricot kernel) 15g - lubricates intestines, promotes downward flow of Qi
Tao Ren (Prunus persica/peach seed) 15g - lubricates intestines, removes stagnation
Bai Zi Ren (Biota orientalis/arborvitae seed) 9g - calms mind, tonifies blood, lubricates intestines
Yu Li Ren (Prunus japonica/bush cherry seed) 5g- lubricates intestines, encourages bowel movements
Song Zi Ren (Pinus tabulaeformis/pine nut seed) 5g - lubricates intestines
Chen Pi (Citrus reticulata/citrus peel) 20g - lubricates intestines, prevents stagnation
Actions: Moistens the Intestines, Unblocks the Bowels
Indications: Deficiency of fluids in the intestines presenting with constipation, dry stool or difficult bowel movements, dry tongue with thin coating, thin and soggy pulse.
4. Formulas that both attack and tonify
黄龙汤Huang Long Tang
Ingredients:
Da Huang (Radix and Rhizoma Rhei)…9g
Mang Xiao (Mirabilitum)…9g (dissolve in hot decoction)
Zhi Shi (Fructus Immaturus Citri Aurantii)…g
Hou Po (Cortex Magnoliae Officinalis)…6g
Ren Shen (Radix Ginseng)…6g
Dang Gui (radix angelicae sinensis)…9g
Jie Geng (Radis Platycodi Grandiflori) 3g
Sheng Jiang (Roasted) (Rhizoma Zingiberis Officinalis, Roasted Fresh Ginger) - 3 pieces.
Da Zao (Fructus Ziziphi Jujubae, Chinese Date, Jujube) - 2 pieces
Gan Cao (Radix Glycyrrhizae Uralensis, Licorice Root) - 3g.
Actions: Clear heat, unblock bowels and tonify Qi and blood
Indications: Constipation or watery diarrhea, abdominal pain that increse with pressure. Fever and thirsty, fatigue, shortness of breath. Dry yellow tongue coating and weak pulse.
5. Formulas that drive out excess water
十枣汤 Shi Zao Tang
Ingredients:
Gan Sui kan-sui root 甘遂
Da Ji euphorbia root 大戟
Yuan Hua genkwa flower 芫花
Da Zao (Fructus Ziziphi Jujubae) 大枣10 pieces
Actions: Drive out thin mucus
Indications: Cough with pain in the chest and hypochondria area, or edema. Shortness of breath, Hard focal distention in the epigastrium, Dry vomiting, headache, vertigo, White slippery tongue coating, Wiry pulse.
