Author: Zhang Zhong-Jing, 張仲景
Year: c. 220
Source: Essentials from the Golden Cabinet (Jin Gui Yao Lue, 金匱要略)
Category: Formulas that Drain Downward
Pattern: Sudden onset of severe Cold Accumulation due to Cold Food Stagnation in the Stomach and Intestines
Key Symptoms: Sudden epigastric and abdominal pain and distention with pain so intense it feels as if "an awl is piercing the abdomen", rough uneven breathing, cyanotic complexion, no bowel movements
Secondary Symptoms: In severe cases there may be loss of consciousness with the mouth tightly closed. This is a life threatening condition and should be referred to hospital.
Tongue: Bluish-purple with a white coating
Pulse: Submerged and tight
Ingredients
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Ba Dou
| 30g | |
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Pinyin: Ba Dou
Chinese: 巴豆
Pharmaceutical: Fructus Crotonis
Taxonomy: Croton Tiglium
English: Croton Fruit |
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Tastes: Pungent, Hot, Toxic
Meridians Entered: Stomach, Large Intestine, and Lung |
Actions & Indications:
- Warmly unblocks and vigorously purges (purges accumulated Cold)
Severe Internal Cold Accumulation leading to constipation, abdominal fullness, distention and pain
Food Stagnation
- Drives out water and reduces oedema
Ascites due to end stage schistomiasis
- Breaks up clogged Phlegm and improves the condition of the throat
Difficult breathing, wheezing, and severe fullness and distention in the chest and diaphragm
Phlegm Blocking the Orifices
- Promotes healing of abscesses and ulcers topically and kills parasites
Abscesses that have suppurated but not ulcerated
Severe ulcers
- Stops diarrhoea
Diarrhoea due to Cold
- Kills Parasites
Insecticide topically
Internally for Gu Sydnrome (Fruehauf, 1998)
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Standard Dosage: 0.1-0.3g powder taken separately.
Cautions: It is contraindicated in pregnancy, those anxious about their health, and is incompatible with Qian Niu Zi.
While not actually on the list of banned and restricted herbal ingredients in the UK it is generally substituted with Wu Zhu Yu due to lack of availability. |
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Gan Jiang
| 30g | |
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Pinyin: Gan Jiang
Chinese: 干姜
Pharmaceutical: Rhizoma Zingiberis
Taxonomy: Zingiber officinale
English: Dried Ginger |
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Tastes: Pungent, hot
Meridians Entered: Spleen, Stomach, Kidney, Heart and Lung |
Actions & Indications:
- Warms the Middle and expels Cold
External Cold affecting the Spleen and Stomach Spleen and Stomach Yang Deficiencies
- Dispels Wind-Dampness seeping into the Lower Jiao
Lower Jiao Wind-Cold-Damp Bi
- Rescues Devastated Yang and expels Interior Cold
Devastated Yang with a very weak pulse and cold limbs
- Warms the Lungs and transforms thin mucus
Lung Cold with expectoration of thin, watery or white sputum
- Warms the channels (unblocks the pulse) and stops bleeding
Haemorrhage due to Deficiency Cold, especially uterine bleeding (only if the bleeding is chronic and pale in colour with cold limbs, ashen white face and a soggy thin pulse)
- Aids fasting
Mentioned in the Shen Nong Ben Cao Jing as part of the middle class of herbs which can, with protracted taking, remove foul smell and enable one to communicate withe Spirit Light (Shen Ming 神明). This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
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Standard Dosage: 3-10g in decoction.
Cautions: It is contraindicated for yin deficiency with internal heat and haemorrhage due to blood heat. |
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Da Huang
| 30g | | |
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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Subsitutions:
In the UK Ba Dou is substituted with Wu Zhu Yu and generally used for less severe presentations but when Cold accumulation needs to be vigorously purged.
Preparation: Ground into powder and taken in 0.6 - 1.5g doses with rice water or warm, boiled water. Maybe be taken in powdered form or rolled into pills with honey. For patients unable to open their mouth it can administered through a nasogastric tube (not usually done in the UK).
Actions: Harshly purges Cold accumulation
Contraindications: Weak and pregnant patients, or in cases of acute abdominal pain due to Heat or Summerheat.
Notes:
Several of the symptoms associated with this formula such as cyanotic complexion, bluish-purple tongue, lack of bowel movement and loss of consciousness are red flags that need to be urgently referred to hospital. Its inclusion is mainly for reference of when it was used historically and may still be in TCM hospitals in China. If used in the UK with Ba Dou substituted for Wu Zhu Yu it may still be a useful for if a less severe presentation is encountered where a strong purgative action for a Cold accumulation is encountered.
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.
