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: Heat and fluids clumping in the chest
Key Symptoms: Fullness and hardness of the epigastrium or entire abdomen with severe pain that becomes unbearable under pressure, tidal fever at dusk, severe constipation, thirst
Secondary Symptoms: Shortness of breath, irritability
Tongue: Very dry coating
Pulse: Submerged, tight and forceful
Abdomen: Distended, hard and painful in the epigastrium or entire abdomen
Ingredients
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Gan Sui
| 0.3-0.6g | | (currently usually 1-1.5g)
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Pinyin: Gan Sui
Chinese: 甘遂
Pharmaceutical: Radix Euphorbia Kansui
English: Sweet Spurge Root |
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Tastes: Bitter, cold, toxic
Meridians Entered: Lung, Kidney, and Large Intestine |
Actions & Indications:
- Drains water downward and eliminates congested fluids and thin mucus
Severe accumulation of fluid in the chest and abdomen Generalized oedema, facial oedema and abdominal distention
- Expels Phlegm
Epilepsy due to Phlegm Blocking the Heart Orifices Seizures from Wind-Phlegm Withdrawal mania from recalcitrant Phlegm congealing and clumping
- Clears Heat, reduces swelling and disperses hardenings
Swollen, painful, nodular Damp-Heat skin lesions (topical-appropriate for early stages, with oral ingestion of herbs that clear Heat and resolve toxicity)
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Standard Dosage: 0.5-1g in powder form. The active form does not dissolve in water so decoction should be avoided.
Cautions: It is contraindicated to the pregnant women and those anxious about their health. It is antagonistic to Gan Cao. |
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Da Huang
| 18g | | (currently usually 9-12g)
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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
| 9-12g | | |
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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Subsitutions:
In the UK two of these ingredients will have to be substituted. Mang Xiao is usually substituted for Yu Li Ren but Gan Sui is such a toxic that forcefully expels water from the body making it difficult to replace without changing the formula entirely.
Yuan Hua has a similar action but is also likely to impossible to source or illegal to use. Zhi Shi could purge the bowel which makes it more or less the same as Da Cheng Qi Tang which focuses on the stool rather than water. Qian Niu Zi and/or Ting Li Zi or some or all of Wu Ling San could be added to drain water downwards via the urine instead of the bowel. Neither entirely copy the function of this formula suggesting that this presentation is hard to treat in the UK and the formula mainly for reference.
Preparation: Decoction. Da Huang is cooked separately with Mang Xiao added at the end and then taken warm with powdered Gan Sui.
Actions: Drains Heat and drives out water by flushing downwards
Contraindications: Due to the strength and toxicity of this formula it is only used for acute conditions, stopped as soon as results are obtained and never taken for more than a few doses. Contraindicated completely in pregnancy or in debilitated patients.
Notes:
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).
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.
