Chinese Medicine : Purgative Formulas

Purgative Formulas

Formulas which have the functions of purging away heat, dispelling cold and removing water retention are called purgative formulas. In general, they may be classified into four categories:

1. Purgative formulas with ingredients of cold nature. They relax the bowels and purge away heat. They are used to treat constipation by heat accumulation.

2. Purgative formulas with ingredients of warm nature. They dispel cold and are mainly used for treating constipation by cold accumulation.

3. Purgative formulas with ingredients for moistening effects. They moisten the intestines and free bowel movements and are used to treat constipation due to dryness of the intestines.

4. Purgative formulas with ingredients for removing water retention. They remove water retention downward out of the body and are used for treating ascites and general edema.

The formulas should be used with caution in persons with weak constitutions and with pregnant women.

DA CHENGQI TANG

Drastic Purgative Decoction

Rhubarb (Dahuang) 12 g
Magnolia bark (Houpo) 15 g
Immature bitter orange (Zhishi) 12 g
Mirabilitum (Mangxiao) 9 g

Method Used: Decoct Magnolia bark (Houpo) and Immature bitter orange (Zhishi) first, then add Rhubarb (Dahuang). When decoction is complete, add Mirabilitum (Mangxiao).

Functions: To purge the bowels and internal heat.

Indications: Excessive syndrome of the Fu organs related to Yang ming channels.

Manifestations and Explanations

Fever
Combination of heat and feces in the intestines.

Constipation, Abdominal pain, distention and fullness, Sensitivity to pressure on abdomen, Dry mouth and tongue
Heat which consumes the body fluids leading to malnutrition of tendons and eyes.

Convulsion, Blurred vision, Yellow, thick and dry tongue coating, Irritability
Mind disturbance by heat.

Delirium, Cold limbs
Accumulation of heat which hinders Yang Qi reaching the limbs.

Deep, rolling and rapid pulse or deep, excess and forceful pulse
Signs of excess pathogenic factors in the interior.

Herbs and Actions:
Rhubarb (Dahuang)
To purge the bowels and internal heat.

Mirabilitum (Mangxiao), Magnolia bark (Houpo)
To promote Qi circulation and bowel movements and to relieve distention and fullness.

Applications: Appendicitis, intestinal obstruction, acute abdominal pain and high fever.

Modifications:
1. Mild damage to body fluids. Delete: Mirabilitum (Mangxiao). This formula is called Xiao Chengqi Tang.
2. Mild abdominal distention and fullness. Replace: Magnolia bark (Houpo) and Immature bitter orange (Zhishi) with Baked licorice (Zhigancao). This formula is known as Tiaowei Chengqi Tang.
3. Severe abdominal distention, fullness and pain. Add: Radish seed (Laifuzi), Peach seed (Taoren) and Red peony (Chishao).
4. Severe Qi and blood deficiency. Add: Ginseng (Renshen), Chinese angelica (Danggui) and Licorice (Gancao). This formula is called Huanglong Tang.
5. Severe dryness in the intestines manifested by constipation. Replace: Magnolia bark (Houpo) and Immature bitter orange (Zhishi) with Scrophularia (Xuanshen), Fresh rehmannia (Shengdihuang) and Ophiopogon root (Maimendong). This formula is called Zengye Chengqi Tang.

Cautions: The formula is contraindicated during pregnancy.

DAHUANG MUDANPI TANG

Decoction of Rhubarb and Moutan Bark Combination

Rhubarb (Dahuang) 18 g
Moutan bark (Mudanpi) 9 g
Peach seed (Taoren) 12 g
Benincasa seed (Dongguazi) 30 g
Mirabilitum (Mangxiao) 9 g

Method Used: All herbs except Mirabilitum (Mangxiao) are cooked first by decoction, then the Mirabilitum (Mangxiao), decocted separately, is added to the decoction.

Functions: 1. To reduce heat and remove stagnation. 2. To disperse lumps and relieve swelling.

Indications: Initial stage of intestinal abscess.

Manifestations and Explanations

Right lower abdominal pain
Damp-heat and stagnation of blood.

Sensitivity to pressure on the abdomen, Hard lumps, Right leg in flexed posture rather than in extended posture
Extended posture of the right leg giving rise to pain.

Fever and chills
Disharmony of Ying (nutrient) and Wei (defensive) systems due to accumulated heat in the blood, leading to poor circulation of Qi and blood.

Rolling and rapid pulse
Excessive heat and dampness in the interior.

Herbs and Actions:
Rhubarb (Dahuang)
To clear heat and release toxins.

Mirabilitum (Mangxiao)
To reduce heat and remove stagnation.

Moutan bark (Mudanpi)
To soften hardness, disperse lumps and relieve swelling.

Peach seed (Taoren)
To invigorate blood circulation, relieve swelling and stop pain.

Benincasa seed (Dongguazi)
To clear heat, drain pus, eliminate dampness and relieve swelling.

Applications: Acute appendicitis.

Modifications:
1. Severe fever. Add: Lonicera flower (Jinyinhua), Dandelion (Pugongying) and Patrinia (Baijiangcao).
2. Severe pain. Add: Red peony (Chishao), Peach seed (Taoren) and Sichuan chinaberry (Chuanlianzi).

Cautions: The formula is contraindicated for ulcerative appendicitis and during pregnancy.

WENPI TANG

Decoction to Warm the Spleen

Rhubarb (Dahuang) 12 g
Aconite (Fuzi) 9 g
Dried ginger (Ganjiang) 6 g
Licorice (Gancao) 3 g
Ginseng (Renshen) 9 g

Method Used: The last four ingredients are cooked with water first, then decocted Rhubarb (Dahuang) is added.

Functions: 1. To warm and tonify the spleen Yang. 2. To drain the cold wastes accumulation.

Indications: Constipation due to cold wastes accumulation.

Manifestations and Explanations

Constipation
Deficiency of spleen Yang which leads to excessive cold and causes Qi stagnation.

Abdominal pain, Abdominal distention, Cold limbs, Chronic dysentery
Deficiency of spleen Yang which leads to excessive cold and impairs the transportation of the intestines.

Pus-like bloody stool, White and watery tongue coating with thick coating on the root of the tongue
Signs of accumulation of cold in the interior.

Deep and tight pulse Herbs and Actions:
Rhubarb (Dahuang)
To drain wastes accumulation.

Aconite (Fuzi)
To warm Yang and dispel cold.

Fresh ginger (Shengjiang)
To check the cold action of Rhubarb (Dahuang).

Ginseng (Renshen)
To tonify Qi in the spleen and stomach.

Licorice (Gancao)

Applications: Chronic dysentery and habitual constipation.

Modifications:
1. Severe abdominal distention and pain. Add: Costus root (Muxiang) and Magnolia bark (Houpo).
2. Tenesmus. Add: Immature bitter orange (Zhishi).
3. Severe nausea and vomiting. Add: Pinellia (Banxia) and Amomum (Sharen).

MAZIREN WAN

Pills of Cannabis Seed Combination

Cannabis seed (Maziren) 500 g
White peony (Baishao) 250 g
Immature bitter orange (Zhishi) 250 g
Rhubarb (Dahuang) 500 g
Magnolia bark (Houpo) 250 g
Apricot seed (Xingren) 250 g

Method Used: The ingredients are ground into powder, then mixed with honey to make pills.

Functions: 1. To moisten the intestines and dispel heat. 2. To promote Qi circulation and promote bowel movements.

Indications: Constipation due to dryness and heat in the stomach and intestines.

Manifestations and Explanations

Constipation
Deficiency of body fluids due to dryness of the intestines.

Abdominal distention and fullness
Qi stagnation.

Herbs and Actions
Cannabis seed (Maziren)
To nourish Yin, moisten dryness and promote bowel movements.

Apricot seed (Xingren), White peony (Baishao), Honey (Fengmi), Rhubarb (Dahuang)
To promote bowel movements and dispel heat.

Immature bitter orange (Zhishi)
To promote Qi circulation, relieve distention and fullness and aid bowel movements.

Magnolia bark (Houpo)

Applications: Constipation.

Modifications:
Constipation due to hemorrhoids. Add: Burnet root (Diyu) and Sophora flower (Huaihua).

Cautions: The formula is contraindicated during pregnancy.

SHIZAO TANG

Decoction of Ten Jujube Combination

Genkwa (Yuanhua) 20 g
Kansui root (Gansui) 20 g
Jujube (Dazao) 10 pcs
Thistle (Daji) 20 g

Method Used: All herbs except Jujube (Dazao) are ground into powder; then 10 pieces of Jujube (Dazao) are decocted separately. The patient takes the decoction with the powder.

Functions: To drain harmful water and fluids.

Indications: Fluid retention in the hypochondrium and edema.

Manifestations and Explanations

1. Fluid retention in the hypochondrium:

Pain in the chest and hypochondriac region
Fluid in the chest impairing the lung Qi.

Pain aggravated by coughing, Stifling sensation in the chest, Shortness of breath, Cannot lie flat, Headache
Upward attack of harmful fluids.

Dizziness, Fullness and hardness in the epigastric region
Upward perversion of the stomach Qi and fluid retention in the epigastric region.

Nausea, Vomiting, Deep and wiry pulse
Excess pathogenic factors in the interior.

2. Edema:

General edema
Retention of the harmful water which remains in the abdomen, permeates the skin, stagnates Qi circulation and impairs the function of the urinary bladder.

Worse edema in the lower limbs, Big abdomen with distention and fullness, Abnormal defecation and urination, Watery tongue coating
Harmful water and fluids in the interior.

Deep, rolling and forceful pulse

Herbs and Actions
Thistle (Daji)
To drain water and dampness in the bowels and viscera.

Kansui root (Gansui)
To drain water and dampness in channels.

Genkwa (Yuanhua)
To drain water and dampness in the chest and hypochondriac regions.

Jujube (Dazao)
To relax the toxic actions of the other ingredients, promote Qi circulation and protect the stomach Qi.

Applications: Pleurisy with effusion and edema.

Cautions:
1. The above ingredients, except Jujube (Dazao), should not be cooked, otherwise they will lose their effectiveness.
2. The formula is contraindicated during pregnancy.
3. It is also contraindicated in persons with weak constitutions.