Chapter 6 Purgative Formulas

Purgative Formulas are mainly composed of purgative herbs with the therapeutic effects of relieving constipation, evacuating gastrointestinal retention, clearing away heat of excess type, purging away excessive fluid and accumulation of cold type. They are indicated for the treatment of interior syndrome of excess type. Interior syndrome of excess varies with the accumulation of heat, cold, dryness and fluid, the constitution of the human body differs with the strong and the weak, the old and the young, the excessive and the deficient. Purgative formulas, therefore, can be further divided into five types: purgative formulas of cold nature, purgative formulas of warm nature, emollient formulas for causing laxation, formulas of eliminating retained fluid and formulas for both reinforcement and elimination.

Section 1 Purgative formulas of Cold Nature

This group of formulas chiefly consists of cold-natured cathartics with the effects of purging away heat and relieving constipation. It is associated with the treatment of excess syndrome of internal heat.

Da Chengqi Tang (Major Decoction for Purging Down Digestive Qi )

Ingredients Rhubarb, Radix et Rhizoma Rhei 12g Magnolia bark, Cortex Magnoliae Officinalis 15g Immature bitter orange, Fructus Aurantii Immaturus 12g Mirabilite, Natrii Sulphas 9g Administrations The above herbs should be decocted in water for oral administration. Magnolia bark and Immature bitter orange are to be decocted prior to Rhubarb. The decoction is to be taken after Mirabilite is infused in it. Functions Expelling pathogenic heat and loosening the bowels, promoting the circulation of qi to purge accumulation in the bowels. Indications l. Excessive-heat syndrome of yangming-fu organ, manifested as constipation, frequent wind through the anus, feeling of fullness in the abdomen, abdominal pain with tenderness and guarding, tidal fever, delirium, polyhidrosis of hands and feet, prickled tongue with yellow dry fur or dry black tongue coating with fissures, deep and forceful pu1se.

2. Syndrome of fecal impaction due to heat with watery discharge, manifested as watery discharge of terribly foul odor accompanied by abdominal distension and pain with tenderness and guarding, dry mouth and tongue, smooth and forceful pulse. 3. Cold limbs due to excess of heat convulsion, mania and other symptoms belonging to excess syndrome of interior heat . Equally, this formula can be modified to deal with infectious or non-infectious febrile diseases in their climax marked by accumulation of heat type, and in the treatment of paralytic, simple and obliterative intestinal obstructions. Modern researches

Modern researches have ascertained that this formula has the functions of relieving inflammation, resisting bacteria, promoting blood circulation of intestines, stimulating intestinal peristalsis, purging stool, tranquilizing the mind, bringing down fever, etc. Cautions l. Being a drastic formula, it must be administered with great care to those of general asthenia, or to those whose external syndrome has not yet been relieved or to those with absence of dry stool in gastrointestinal tract. 2. The drastic effect of this formula is harmful to the stomach-qi. So, immediate withdrawal is indicated once the effect attained. Over-administration is Prohibited. 3. Never is it administered for pregnant women.

Xiao Chengqi Tang ( Minor Decoction for Purging Down Digestive Qi )

Ingredients Rhubarb, Radix et Rhizorma Rhei 12g Magnolia bark, Cortex Magnoliae officinalis 6g Immature biter orange, Fructus Aurantii Immaturus 9g Administrations All the herbs except Rhubarb which is to beadded later should be decocted in water for oral administration. Functions Relieving heat accumulation by mild effect.

Indications Mild cases of excess syndrome of yang-ming fu organ, manifested as delirium, tidal fever, constipation, distension and fullness in the chest and abdomen, yellow shriveled tongue coating, smooth and swift pulse as well as the onset of dysentery with distending abdominal pain or epigastric fullness, tenemus and so on. Tiaowei Chengqi Tang

( Purgative Decoction for Coordinating the Function of stomach ) Ingredients Rhubarb, Radix et Rhizoma Rhei 12g Liquorice, Radix Glycyrrhizae 6g Mirabilite, Natrii Sulphas 12g Administrations The above herbs are decocted in water with the exception of Mirabilite which is infused in the decoction just before the oral dose. Functions Purging pathogenic heat accumulated in the gastrointestinal tract by laxative action. Indications Yangming disease marked by gastrointestinal dryness and heat, manifested by of obstruction of defecation, thirst and vexation, fever like steaming, abdominal distension and fullness,delirium, yellow tongue coating, slippery and rapid pulse as well as eruption, hematenesis, epistaxis, painful swelling of mouth, teeth and throat caused by domination of heat in the intestine and stomach. It can also be indicated for the cases with mild abdominal fullness.

Da Xianxiong Tang ( Major Decoction for Removing Phlegm-heat from Chest )

Ingredients Rhubarb, Radix et Rhizoma Rhei 10g Mirabilite, Natrii Sulphas 10g Kansui root, Radix Euphorbiae Kansui lg Administrations Rhubarb is decocted in water priorly, and Mirabilite is dissolved posteriorly. The decoction is to be taken after Kansui root is ground into fine powder and is infused in boiling water or in the decoction. Functions Purging heat and removing water retention by hydragogue.

Indications Syndrome due to accumulation of pathogenic heat with stagnancy of fluid or phlegm in the chest, manifested as fullness, pain and tenderness of the area from the epigastrium to the lower abdomen where the patient may feel too painful to be touched, constipation, mild tidal fever as well as restlessness and shortness of breath. thirst and dryness of the tongue, sunken, tense and forceful Pulse. Equally, this formula can be modified to deal with inflammatory hydrothorax and ascites, acute edematous pancreatitis or severe cases of intestinal`obstruction and others which pertain to the accumulation of pathogenic heat with stagnancy of fluid or phlegm in the chest. Modern Researches Clinically and experimentally, it is ascertained that this Formula has the efficacies of purgation, diuresis, antiinflammation and antisepsis. Cautions 1. The administration should be withdrawn immediately after thorough purgation is achieved, The secondary administration is necessary for those without thorough purgation. Since the formula is indicated for the treatment of acute diseases, the prescribed dosage should be strictly observed to avoid impairment of the vital qi, but the pathogens should be purged promptly so, as to prevent the persistence in the body . 2. The administration is prohibited for those with weak constitution or those who have just recovered from the illness and can not bear the drastic effect of the formula.

Section 2 Purgative Formulas of Warm Nature

This kind of Formulas, composed of purgatives together with herbs of warm nature, has the effects of warming and relaxing the bowels and expelling the accumulation of cold nature. It is preferred for the treatment of syndrome of interior excess due to the accumulation of pathogenic cold.

Daihuang Fuzi Tang (Decoction of Rhnbarb and Aconite)

Ingredients Rhubarb, Radix et Rhizoma Rhei 9g Prepared aconite root, Radix Aconiti Praeparata 9g Asarum herb, Herba Asari 3g Administrations All the above herbs are to be decocted in water for oral administration.

Functions Warming yang and dispelling pathogenic cold, relieving constipation and promoting the circulation of qi. Indications Syndrome of interior excess due to the accumulation of pathogenic cold, manifested as abdominal pain, constipation, hypochondriac pain, fever, cold limbs white and greasy coating on the tongue, taut and tense pulse. Besides, this formula can be modified to deal with such cases as acute or chronic constipation accompanied with accumulation of pathogenic cold, acute appendicitis, intestinal obstruction ascribable to insufficient-cold type. Modern Researches Modern researches have proved that this formula possesses the efficacies of promoting metabolism and blood circulation as well as cardiac stimulant, analgesia and purgation. Cautions 1. Generally, the dosage of rhubarb should not exceed that of prepared aconite root. 2. If the administration of this formula results in the relief of constipation, the patient can be pronounced to be out of danger, but if the patient does not respond well to the formula marked by constipation, vomiting, cold limbs and thready Pulse, it indicates that the patient is still in danger.

Wenpi Tang (Decoction for warming spleen )

Ingredients Rhubarb, Radix et Rhizoma Rhei 12g Prepared aconite root, Radix Aconiti Praeparata 9g Dried ginger, Rhizoma Zingiberis 6g Ginseng, Radix Ginseng 9g Liquorice, Radix Glycyrrhizae 3g Administrations All herbs are to be decocted in water with Rhubarb decocted later so as to preserve its available composition. The decoction is for oral administration. Functions Warming and invigorating the spleen-yang and eliminating cold accumulation. Indications Constipation caused by accumulation of cold due to hypofunction of the spleen, marked by periumbilical cold-pain which will be alleviated with a warm hand on the region, also may be used to

treat protracted diarrhea accompanied by abdominal pain, epigastric fullness, cold extremities, white tongue fur, deep and taut pulse. Equally, the formula can also be modified to treat the following cases, constipation due to insufficiency of yang as seen in chronic gastritis, enteritis and other chronic illness, or chronic diarrhea due to insufficiency of yang as seen in the cases or chronic dysentery, chronic ulcerative colitis intestinal tuberculosis, etc. Modern researches Modern researches have verified that this is a popular formula for anti-inflammation, antisepsis, promoting circulation, increasing physiologic function, stimulating peristalsis, exciting nervous center, promoting digestion and absorption, stimulating heart functions, etc. Cautions Prepared aconite root should be decocted for 30 to 60 minutes in water prior to other ingredients so as to lessen its toxicity, while rhubarb should be added into the decoction posterior to all other ingredients lest its Purgative action should be reduced.

Section 3 Emollient Formulas for Causing Laxation

The formulas of this kind are chiefly made up of emollient cathartics and have the function of causing laxation. They are indicated in constipation due to intestinal dryness resulting from insufficiency of body fluid.

Maziren Wan (Hemp Seed Pill )

Ingredients Hemp seed, Fructus Cannabis 500g White peony root, Radix Paeoniae Alba 250g Fruit of immature citron, Fructus Aurantii Immaturus 250g Rhubarb, Radix et Rhizoma Rhei 500g Magnolia bark, Cortex Magnoliae officinalis 250g Bitter apricot kernel, Semen Armeniacae Amarum 250g Administrations The above herbs are ground into fine powder and then boluses are made out of powdered medicines mixed with honey, just the same size as a parasol seed. Nine grams is taken each time orally with warm boiled water, one or two times a day. This formula may be decocted for internal administration, but the dosage must be reduced in proportion to that of the original formula.

Functions Moistening the intestines to relieve constipation. Indications Syndrome of constipation due to intestinal dryness, manifested as frequency of urination, dry stool, or constipation due to dehydration after febrile diseases, and habitual constipation. This formula can equally be adapted for the treatment of constipation caused by intestinal dryness due to over-sweating in the febrile diseases, habitual constipation marked by rabbit-stool-like feces. Modern researches Modern researches have confirmed that this formula has the functions of moistening the intestine and softening stool. Cautions 1. The formula should be administered with great care for the aged and the weak or those with constipation caused by exhaustion of body fluid and blood dryness without pathogenic heat. 2. It is not advisable for the pregnant women.

Section 4 Formulas for Eliminating Retained Fluid

This group of formulas consists of drastic purgatives and functions in eliminating excessive retained fluid. It is used in the treatment of hydrothorax, ascites and edema of excess type.

Shizao Tang ( Ten Chinese-dates Decoction )

Ingredients Parched genkwa, Flos Genkwa Kansui root, Radix Euphorbiae Kansui Knoxia root, Radix Knoxiae All the above herbs should be equal in dosage. Administrations The above herbs, mixed and ground into fine powder or then put into capsules, are taken 0.5-1g each time, once a day, with the decoction of 10 Chinese-dates. When the patient has drastic watery diarrhea, it is recommended that a diet of porridge be taken to benefit recovery.

Functions Drastically expelling the excessive fluid. Indications Pleural effusion and edema, manifested by pain in the chest and hypochondrium when coughing or spitting, hardness and stuffiness in the epigastrium, retching, shortness of breath, headache with halo, difficult respiration due to pain in the thorax and back, slippery coating on the tongue, sunken and taut pulse, or edema which is more serious in the lower part of the body, abdominal fullness, dyspnea, difficulty in urination and defecation. Moreover, the modified formula is also used to treat hydrothorax, ascitcs and edema caused by exudative pleurisy, hepatic cirrhosis, acute pancreatitis, chronic nephritis and nephrotic syndrome, etc.; or simple intestinal obstruction, acute gastric dilatation and others that are ascribed to strong body resistance with exuberance of Pathogenic factors. Modern researches Modern researches have confirmed that this formula can produce drastic effect of purgation and obvious effect of diuresis by stimulating the intestinal mucosa to Produce inflammatory congestion and violent peristalsis. Cautions 1. This formula is advisable only to those who have excessive fluid and are in stout constitution. When the rapid purgation occurs, the administration must be withdrawn. If the purgation is not thorough, which suggests incomplete re-moval of fluid retention, the administration may be continued depending on the health condition. 2. If the purgation is required for patients with excessiveness of pathogen and general debility, there are several methods available in accordance with the patient's condition, such as the method of administering medicines to drive out the pathogenic factors first and then give tonics for recuperation, the method of administering tonics first to improve the patient's general condition and then give drastic herbs to drive out pathogens, and the method of administering medicines to drive out invading pathogens and give tonics to reinforce the body resistance at the same time. When the patient's general condition takes a favourable turn, the treatment should be aimed at warming and replenishing the kidney-qi and recuperating the spleen and stomach. 3. It is never administered for pregnant women and the patients with weak health condition without excessiveness of pathogens.

Section 5 Formulas for Both Reinforcement and Elimination

This kind of formulas is chiefly made up of purgatives and tonifying herbs and possesses double properties of reinforcement and elimination. They are usually indicated for the treatment of syndrome of interior excess due to accumulation of pathogens with interior deficiency of the vital qi.

Xinjia Huanglong Tang ( Decoction of Yellow Dragon with Supplements )

Ingredients Slim dried rehmannia root, Radix Rehmanniae 15g Liquorice, Radix Glycyrrhizae 6g Ginseng, Radix Ginseng 4.5g Rhubarb, Radix et Rhizoma Rhei 9g Mirabilite, Natrii Sulphas 9g Scrophularia root, RaJix Scrophulariae 15g Ophiopogon root, Radix Ophiopogonis 15g Chinese angelica root, Radix Angelicae Sinensis 4.5g Sea cucumber 2 pieces Ginger juice 6 spoonfuls Administrations The above herbs should be decocted in water for oral administration. Functions Nourishing yin, replenishing the vital qi and purging the accumulation of pathogenic heat. Indications Syndrome of the accumulation of heat accompanied by weakened body resistance with such symptoms as constipation, abdominal fullness and distension mental fatigue, shortness of breath, dryness of the mouth and throat, parched or chapped lips with fissures on the tongue, dry scorched yellow or black tongue fur. Equally, this formula can be modified to treat paralytic, simple and obliterative intestinal obstruction, habitual constipation, epidemic or non-epidemic febrile diseases in their climax marked by interior excess and accumulation of heat, and effective for those with deficiency of the vital qi and massive loss of yin and blood. Modern researches Modern researches have confirmed that this formula has the efficacies of relieving inflammation, resisting bacteria, improving intestinal blood circulation and intestinal Peristalsis, increasing the activity of gastrointestinal tract, loosing the bowels, tranquilizing the mind and bringing down fever.

Cautions Ginseng should be decocted alone, and then poured into the decoction of other ingredients before intake.