Author: Zhang Zhong-Jing, 張仲景
Year: c. 220
Source: Discussion of Cold Damage (Shang Han Lun, 傷寒論)
Category: Formulas that Drain Downward
Pattern: Excess Heat clumping in the Yangming, Yin Wei Mai Heat pain with Taiyin pattern.
Key Symptoms: Constipation and flatulance, abdominal pain and distention that increases with pressure, irritability and restlessness
Secondary Symptoms: Profuse sweating from the palms and soles or the head, tidal fevers, delirious speech, disorientation, cracked lips, dark scanty urine
Tongue: Red body with dry, yellow or black coating, maybe prickled
Pulse: Deep, or deep and excessive, rapid and slippery
Abdomen: Distended and painful that worsens with pressure, focal distention in epigastrium
Ingredients
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Da Huang
| 6-12g | | (add near end)
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Pinyin: Da Huang
Chinese: 大黄
Pharmaceutical: Radix et Rhizoma Rhei
Taxonomy: Rheum palmatum
English: Chinese Rhubarb Root |
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Tastes: Bitter, cold
Meridians Entered: Large Intestine, Spleen, Stomach, Liver and Heart |
Actions & Indications:
- Drains Heat and purges accumulations
Intestinal Heat Excess, with high fever, profuse sweating, thirst, constipation, abdominal distention and pain, delirium, a yellow tongue coat and a full pulse
Yang-Ming Fu Stage
Qi Level Heat in the Intestines
- Drains Fire
Fire from Excess with intense fever, sore throat, and painful eyes and constipation
Fire toxin sores due to Xue Level Heat, especially with constipation
- Clears Heat, transforms Dampness and promotes urination
Damp-Heat with oedema, jaundice, painful urinary dysfunction and acute, hot dysenteric disorders
- Drains Heat from the Blood
Bloody stool either from hemorrhoids or Heat in the Intestines
Chaotic movement of hot Blood with hemoptysis or epistaxis with constipation
It can be powdered and administered orally for bleeding in the upper digestive tract
- Invigorates the Blood and dispels Blood Stasis
Blood Stasis with amenorrhea, fixed abdominal masses or fixed pain
Blood Stasis due to traumatic injury
Intestinal abscess
- Clears Heat and reduces Fire toxicity
Topically or internally for burns or skin lesions (Chuang Yung) due to Heat
- Clears Heat and eliminates Phlegm
Chronic Accumulation of Phlegm-Heat with cough, dyspnea, mania, disorientation and other symptoms of Phlegm Misting the Heart
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Standard Dosage: 10-15g in decoction. Excessive decoction will reduce the purgative action. Therefore it should be added at end to achieve this purpose and over-decocted to eliminate this action.
Cautions: It should be used with caution in case of spleen and stomach deficiency for its bitter and cold property which is easily to damage stomach qi. It is contraindicated to women during pregnancy, menstruation or lactation for it has actions of activating blood and resolving stasis, and can make the purged substances follow lactating out. |
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Mang Xiao
| 9g | | (dissolve into strained decoction)
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Pinyin: Mang Xiao
Chinese: 芒硝
Pharmaceutical: Natrii Sulfas
Taxonomy: Na2SO4·10H2O
English: Glauber's Salt / Mirabilite |
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Tastes: Salty, bitter, cold
Meridians Entered: Stomach and Large Intestine |
Actions & Indications:
- Purges accumulations, guides out Stagnation, softens hardness and moistens Dryness
Heat in the Stomach and Intestines with constipation and hard knots
- Clears Heat and drains Fire
Heat in the Stomach or Lungs especially accumulated Phlegm or clumping in the Intestines
- Clears Heat and reduces swelling
Red, swollen, painful eyes
Painful, ulcerated, swollen mouth or throat (topical)
Red, swollen skin lesions (topical)
Mastitis (topical) (promotes lactation)
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Standard Dosage: 10-15g dissolved into decoction at end.
Cautions: Use with caution for women during lactation for its milk regurgitation action. It is contraindicated to pregnant women.
Mineral products are prohibited from use in the UK under the Medicines Act 1968 ch. 67 which restricts herbalists to the use of plant products only. It is generally substituted with Yu Li Ren. If the osmotic laxative effects of salts are required then Epsom salts (magnesium sulfate) are more commonly available in the UK, although they still come under the same laws and would have to be included as lifestyle advice, to be sourced and dosed by the patient, not prescribed and given by the herbalist. |
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Zhi Shi
| 12g | |
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Pinyin: Zhi Shi
Chinese: 枳实
Pharmaceutical: Fructus Aurantii Immaturus
Taxonomy: Citrus aurantium
English: Immature Seville Orange / Immature Bitter Orange / Immature Sour Orange |
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Tastes: Pungent, bitter, slightly cold
Meridians Entered: Spleen, Stomach and Large Intestine |
Actions & Indications:
- Breaks up Stagnant Qi, reduces accumulation, descends Qi, unblocks the bowels and removes Stagnant Food
Qi Stagnation and accumulation with epigastric or abdominal pain and distention or indigestion with focal distention or gas
Food Stagnation
- Transforms Phlegm, reduces distention and resolves hardenings
Turbid Phlegm Obstructing the Qi with focal distention and fullness in the chest and epigastrium
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Standard Dosage: 3-10g in decoction.
Cautions: It should be used with cautions for pregnant women. |
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Hou Po
| 15-24g | | |
Pinyin: Hou Po
Chinese: 厚朴
Pharmaceutical: Cortex Magnoliae
Taxonomy: Magnolia officinalis
English: Magnolia Bark |
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Tastes: Bitter, pungent, warm
Meridians Entered: Spleen, Stomach, Lung and Large Intestine |
Actions & Indications:
- Promotes the movement of Qi in the Middle Jiao and resolves Stagnation
Abdominal, epigastric, and/or chest fullness, bloating, loss of appetite, poor digestion, constipation
Plum Pit Qi, a feeling of a lump in throat, usually considered psychosomatic today (globus hystericus). Hou Po has modern indications as neuroprotective and also features in formulas like Da/Xiao Cheng Qi Tang which deal with neuropsychiatric symptoms like delirium.
- Promotes the movement of Qi downward, dries Dampness and transforms Phlegm
Dampness or Phlegm Obstructing the Middle Jiao with distention, fullness, nausea and diarrhoea
- Descends Rebellious Qi, reduces Phlegm and calms wheezing
Cough and wheezing due to Phlegm congesting the Lungs
- Removes the Three Worms
Said in the Shen Nong Ben Cao Jing that it removes the Three Worms. These may refer to difficult to treat metabolic disorders caused by overindulgence and should be accompanied by fasting, meditation and exercise regimes.
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Standard Dosage: 3-10g in decoction.
Cautions: It should be used with cautions for the syndrome of qi deficiency and fluid consumption, and in pregnant women. Due to some of the anticoagulant effects of its constituents it should be used with caution in conjunction with blood thinners. |
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Subsitutions:
In the UK Mang Xiao must be replaced with Yu Li Ren.
Preparation: Decoction.
Actions: Vigorously purges Heat accumulation
Contraindications: Pregnancy, deficient patients without modification as may cause vomiting or diarrhoea
Notes:
Extraordinary Vessel attributions come from Li Shi-Zhen's (1577-8) Exposition on the Eight Extraordinary Vessels (Qi Jing Ba Mai Kao), trans. Chace & Shima (2009). The text only states "Cheng Qi Tang" potentially meaning any of the decoctions that end in this name.
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One liang is taken as 3g in modern sources but in Eastern Han times it was equivalent to 13.875g. This means that the dosages in classical formulae could have been more than 4x what is given today making them far higher than recommended safe dosages today but prompts consideration of what an effective dose may be (He, 2013).
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Ploberger (2017), in Westliche und traditionell chinesische Heilkräuter, offers the following alternative using western herbs:
| Radix et Rhizoma Rhei | (Rhubarb root) | 9g | (Emperor) |
| Radix Barbanae | (Burdock root) | 4g | (Minister) |
| Herba Menthae | (Peppermint) | 3g | (Assistant) |
| Percarpium Citri ret. | (Orange peel) | 3g | (Minister) |
Research Links:
Reference Notes: (click to display)
Most formulas are found in Scheid, Bensky, Ellis & Barolet (2009): Chinese Herbal Medicine: Formulas & Strategies and Chen & Chen (2015) Chinese Herbal Formulas and Applications. Others are from translations of primary sources. It is recommended that the original material is cross-referenced for mistakes and additional information.
Substitutions have been taken from Ken Lloyd & Prof. Leung (2004): Mayway UK Substitution List or the above publications and are intended as suggestions to help navigate the tight restrictions in the UK quickly. More applicable substitutions may be appropriate in specific situations.
Individual herb information has initially been sourced from TCM Wiki and American Dragon for basic data and then updated manually with my own notes.
These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.