Chapter Two Purgative Formulae

Purgative formula are mainly composed of purgative herbs which have the effects of purging heat to relieve constipation, purging cold accumulation, and moistening intestines to ralievc constipation. They arc all used to treat constipa tion syndromes due to interior excess and pertain to the purgative therapy of the eight therapies.
Cnnstipation,also called difficulty in defecation, refers to dry end solid feces, difficulty in discharge with lunger time of defecation or no bowel movement fur more than two or three days. “The six fu viscera play fuoctiuns well only when unubstruction”. Constipation reflects that the formed excessive evil is stayed and accumulated in the interior, which leeds to failure of the fu viscerel qi in descending. The common sympturns of the interiur excessive syndrome crc stuffiness, full ness, distention end pain of epigastrium end abdomen, constipation, pour appetite, thick coeting, etc.
According to the principle proposed in Grand Discussion on Yin-Yang Corresponding to Natural Phenomena in the Plain Questions,the interior excessiveness in the lower pert should be purged, the above syndrome should be treated with pur gative therapy. The causes leading to constipation can be divided into cold, heat, deficiency end excess, so this kind of formulae can also be divided into three categories, i. e. cold purgative, warm purgative end moistening purgative formulae. Meanwhile, the condition of the excessive syndrome is different. lt can he light or heavy, it’s course can be long or short, sn there are the divisions of drastic purgation and moderate purgation in the particular treatment methods. As for the meth ods of expelling phlegm, dissipating stasis, expelling parasites and purging water, they also belong tu purgative therapy. But they will be discussed respectively in particulay chapters and referred each other.
Purgative forniulee are particularly set up for constipation due to interior cx cess. If no relief of the exterior syndrome and without the interior excess the purgative formulae shuuld nut be used. If no complete relief of exterior syndrome but the interior excess formed, it needs to relieve the exterior first and purge the intc nor later, or relieve the exteriur end interior simultaneously according to the sen uusncss of exterior and interior syndromes. Except the moistening purgative fur62
mulae, all the purgative furmulae are comparatively drastic so it should be cautious to apply them to cases of aged patients constitutional deficiency, pregnant women, postpartum, consumption of body fluid or blood lose after illness. It should base on the conditions of deficiency ur excess, moderation or emergency to apply purgation first and to care the dcficicncy later or tu apply both purgation and reinforcement simultaneuusly. Besides, the purgative formulae can injure the stomach-qi easily, so they cannot be overused. Attention should also be paid to diet restriction. The greasy food and indigestible food should not be taken until enoogh recovery in order to prevent from re-injaring the stomach—qi and resulting
in food retention. -
Section 1 Cold Purgative Formulae
Cold purgative formulae are applied to constipation due to heat accumulation and interior excessiveness, that the exuberant heat leads to fever or aversion to heat; in] ory of body fluid brings ahoot dry stool; obstruction of fu-visceral qi and retention of turbid qi and interior heat causes stuffiness, fullness, distention and pain of epigastrium and abdomen, yellow and thick coating. In addition, symptoms pertaining to fire evil disturbing the heart, the liver-fire prodocing wind, heat scorching the genuine yin and consuming qi and blood, and syndromes pertaining to stagnated blood, damp-heat, internal fluid-retention can also be accompanied by the hear constipation. They all should be treated with method of purging heat to relieve constipation. Rhubarb and mirabilite can porge heat as well as relieving constipation. They are usually used together as the main herbs. For follness and distention of epigsstriom and abdomen, magnolia bark, onripcned bitter orange and aocklandia root con he used as assistants to activate qi for relieving distention. If the condition is accompanied with blood stagnation, peach kernel, red peony root and mootan bark can be added to activate blood for resolving stasis. If it is accompanied with damp-heat, waxgourd seed and coix seed can he used together to clear dampness and heat. If it is accompanied with internal fluid—retent ion inte grated with heat, kansui rant can be added to purge fluid retention. Far the exuberant heat injuring yin, rchmannia rant, scrophularia root and ophiopogon rout can be cooperated to nourish yin for promoting production of body fluid. Fur con sumption of qi and blood, pilose asiahell root and Chinese angelica root can be added to replenish qi and nourish blood. For the exoberant interior heat, scutcllaria root, cape] asmine fruit and forsythia fruit can be used together to clear heat and
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fire If it is accompanied with the exterior syndromes, certain exterior relieving herbs can be added. The representative formulae are Major Purgative Decoction, Rhubarb and Moutan Bark Deeoetion and Major Deeoetion for Chest Congestion, etc.
Major Pnrgative Decoction
dd chéng qI tang
SOURCE: Treatise on Cold-Attack
INGREDIENTS:
Rhubarb 1 2g
Magnolia bark 15g
Unripened hitter orange l2g
Mirabilite 9g
DIRECTION5:Deeoet the above herbs in water for oral administration. The unripeoed hitter orange and magnolia hark are decoeted prior to rhubarb. The deeoction could be taken warmly twice a day after mirabilite is infused in it. Whenever constipation is relieved, medication should be stopped.
EFFECTS:Drastically purging the heat caaumolation.
INDICATIONS:
(1) Excessive syndrome of Yangming fu viscera maoifested by tidel fever, delirium, frequent fart, constipation, continuous sweating of limbs, abdominal dis-, tention with tenderness, prickled tongue with yellow and dry coating, or dry and black coating with fissures, slow slippery pulse, or deep, slow and forceful pulse.
(2) Syndrome of heat accumulation with watery discharge marked by watery diarrhea with terrible fool odor, abdominal pain, dryness of mouth arid tongue, rapid slippery pulse or slippery forceful pulse.
(3) Cold limbs, convulsion or mania pertaining to excessive syndromes of in tenor heat.
ANALYSIS OF FORMULA:This is a representative formula for purging heat accumulation drastically. Rhubarb is the main herb which can purge heat for relieving constipation and clear gastrointestinal tract as well as activating blood for removing stasis. Being salty flavor and cold nature, mirabilite acts as the assistant herb to soften hardness and moisten dryness for relieving constipation, which strengthens the purgative power of thoharb. As the adjuvant herbs, magnolia bark and unripened hitter orapge activate qi and dissolve accumulation for fullness and stuffiness, which help rhubarb and mirabilite in clearing.
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This formula can he applied to acute simple intestinal obstruction, adhesive intestinal obstruction, ascaris intestinal obstruction, ascariasis of biliary tract, a— cute pancreatitis, acute appendicitis, and the beginning uf acute bacterial dysentery pertaining to the excessive syndrome of Yangming fit viscera.
This formula cannot be overused because of its drastic purgative effect.
ASSOCIATED FORMULAE:
(1) Minur Purgative Decnctiun (rida chfng qi tang) , (Treatise an Cold At tack)
Rhubarb 12g, magnolia hark 6g, unripened hitter orange 9g.
The above herbs should be decocted in water fur oral adrninistratinn. It is used to treat syndrome of Yangming fit-viscera marked by delirium, constipation, tidal fever, stuffiness and fullness of epigastrium and abdomen, yellow shivered coating, slipery rapid pulse; or the initial stage of dysentery with symptoms of severe abdominal pain, or distention of abdomen with tenesmus.
(2) Stomach Regulating Purgative Decnctinn (tido ruth chéng qi tang) (Treatise on Cold-Attack)
Rhubarb J 2g, Roasted licorice root 6g, mirshilite 9g.
The above herbs should be decocted in water with the exception of mirabilite which should be dissolved in the decactian. It can be used to treat Yangming dis eases manifested by aversion to heat, thirst, constipation, abdominal distention with tenderness, yellow coating and slippery rapid pulse.
NOTES: All the three Purgative Decuctions are taken rhubarb as the main herb to clear the accumulated heat in gastrointestina’ tract and all are applied to heat accumulation syndrame of Yangming. The Major Purgative Decactian is a drastic purgative formula for treating the heavy syndrome of heat accomulalion of Yangming including all the stuffiness, fullness, dryness and excessiveness. The Minor Purgative Decnctinn is a moderate purgative formula for treating the light syndrome of heat accumulation of Yangming only including the stuffiness, fullness and excessiveness. Stomach-Regulating Purgative Decoctiun is a light purgative furmrda for treating heat accumulation syndrnnie of Yangrning withnut stuffiness and fullness.
Rhubarb and Muutan Bark Deeoetion
dd huhng ma dan tang
SOURCE: Synopsis of the Golden Chomber
INGREDIENTS:
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Rhubarb 12g
Moutan bark 6g
Peach kernel 9g
Waxgourd seed 30g
Mirabilite 9g
DIRECTIONS: Decoct the above herbs in water for oral administration and dissolve the mirabilite in the decoction.
EFFECTS:Furging heat and stasis to dissolve accumulation and swelling.
INDICATIONS: The beginning of intestinal abscess without pus formation manifested by fever, sweating, pain of the right lower abdomen with tenderness and or flexion of the right leg.
ANALYSIS OF FORMULA: This is a common formula for intestinal abscess due to damp heat. As the main herbs, rhubarb can purge intestinal damp heat and poison as well as activating blood for dissipating stasis; muutan hark can clear a way heat to cool blood and resolve stasis to diminish congestion. Mirabiliter assists rhubarb in softening hardness and dissolving accumulation; peach kernel acti yates blood for brealcing stasis. They both act as the assistant herbs. waxgourd seed as an important adjuvant herb for internal abscess disperses dampness for draining pus and resolving swelling and accumulation.
This formula is commonly applied to acute appendicitis, annexitis and pelvic inflammation pertaining to internal accumulation of damp-heat.
Major Decoction for Chest Congestion
xido xiàn xiöng tang
SOURCE: Treatise on Cold-Attack
INGREDIENTS:
Rhubarb Jog
Mirahilite 12g
Powder of kansul root 1. 5g
DIRECTION: Dccuct rhubarb in water first and then dissolve mirabilite in decnction. The powder of kansui root is put in befure decoctiun is prepared-It has to he stopped taking immediately when purgation is achieved.
EFFECT:Purging heat and water.
INDICATIONS: Blocked up chest syndrome manifested by canstipatiun fur five or seven days, dryness of tongue with thirst, fullness, pain and tenderness of epigastrium, shortness of breath, fidget, mild tidal fever in afternoon, deep, tight
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and forceful pulse.
ANALYSIS OF FORMULA: This is a drastic formula for purging heat and water. As the main herbs, kansui root, with the bitter flavor and cold nature, pur ges water and heat drastically so as to induce water and heat evils out through urine sod stool; being bitter flavor and cold nature, rhubarb purges and clear the heat evil. Mirahilhe as the assistant herb purges heat and soften hardness to resolve mass.
Tn the present clinic, this formula is commonly applied to acute edematous panereatitis, acute intestinal ubstruetiun with the shove mentioned symptoms.
Section 2 Warm Purgative Formulae
Warm purgative furmulae are applied to constipation due to cold secumula tinn and interior excessiveness. If the cold accumulation is resulted from eating too much cold fond at one meal which leads iii stagnation of gastrointestinal qi, there would be sudden onset of disease with severe stabbing pain of epigastrium and abdomen, even lockjaw and sudden syneape. if the cold accumulation is due to deficient cold of the spleen and stomach with dysfunction in transporting end trans forming, there would be symptoms of constipation, abdominal pain with hardness by palpilatinn, preference for hat drink, end cold limbs. Fur the sudden attack of cold accumulation, eruton seed is used as the main herb to purge the cold aeeumu latinn. in clinic, ernton seed is usually used together with rhubarb which can assist erutun seed is purging accumulation and mitgate the toxicity of erotan seed. Far the general cold accumulation caused by the deficient cold of the spleen and stomach, dry ginger, prepared acanite lateral root and rhubarb are used as the main herbs to warm meridians for expelling cold and to purge the cold eeeumuletiun. The representative formulae are Rhubarb and Aennite Deenctinn, Spleen Warming Decuctinn and Three Herbs Emergency Pills.
Rhubarb and Aconite Decoction
dcl hudng fcl zi tang
SOURCE:Synnpsis nf the Golden Chamber
INC REDIENTS:
Rhubarb Pg
Prepared aeonite lateral root 12g
Asarurn herb 6g
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DTRECTION:Decoci the above herbs in waler for oral adnunistration.
EFFECTS: Warming meridians to dispel cold, relieve constipation and assuage pain.
INDICATIONS: Cold accumulation manifested by abdominal or hypochondriac pain, constipation, fevcr, cold limbs, dccp, taut and tight pulse.
ANALYSIS OF FORMULA: Being extremely pungent flavor and extremely hot nature, the prepared aeonite lateral root warms the interior to dispell cold and assuage cold pain of epigastriorn snd abdomen; rhubarb purges feces. Both of them act as lhe main herbs. The formula becomes the worm purgation because the dosage of prepared sconite lateral root is larger thsn that of rhubarb. As the assistant herb, asarum herb activates yang snd expels cold to slleviate pain.
It is commonly used by Zhang Zhongjing to apply both asarum herb and prepared seonite lateral root to treat the latent cold evil in yin-phase. The examples can he seen in this formula and in Ephedra, Aeonite and Asarom Deenction. In the latter, working with ephedra, the osarum herb is mainly to assist ysng in relieving the exterior;while in the former, Working with rhubarb, assrum herb helps pre pared aconite lateral root to change the hitter-cold formula into warm purgation. It is especially worth to mention that the dosage of prepared sconite lateral root in this formula is far larger than that in Ephedrs, Aeonite and Asarurn Deenetion. So it is clear that there is a profound meaning in the aspects of setting therapies, choosing herbs and creating formulae by the ancients.
Spleen-Warming Decoction
Wën p1 tang
SOURCE: The Essential Formulae Worth A Thousand Gold for Emergency
INGREDIENTS:
Rhubarb 12g
Prepared sconite lateral root 12g
Dry ginger 6g
Ginseng 6g
Licorice root Gg
DIRECTIONS:Deeoet the above herbs in water for oral administration except rhubarb which should be pot in posteriorly.
EFFECTS:Worming spleen yang and porging cold aeeomolation.
INDICATIONS:Cold accumulation marked by constipation, or chronic dysentery with whitish and reddish mucus, obdominsl pain, cold limbs, deep and tout
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pulse.
ANALYSIS OF FORMULA: This is a representative formula for deficiency of the spleen—yang with cold accumulation. If only to purge the cold accumulation, it may injure the middle yang; if only apply worming therapy, it will be difficult to remove the cold accumulation. So the only method is to warm the spleen yang and to purge cold accumulation simultaneously. The cnmhinatiun of prepared aconitc lateral root and rhubarb, both as the main herbs, warm the interior for dispelling cold and purge the cold accumulation. Being pungent flavor and hut nature and as the assistant herb, the dry ginger specializes in warming the spleen—yang to assist prepared acunitc lateral rout in expelling cold coagulation. (hnseng is ihe adjuvunt herb, with sweet flavor and warm nature, to invigorate the middle-qi as well as preventing injury of the spleen and stomach-qi caused by over purgation. As the dispatcher herb, licorice root can strengthen ginseng in invigorating qi as well as harmonizing all the components.
This formula and Rhubarb and Aconitc Dccoction share the identical niain herbs which are used to warm the interior fur expelling cold evil and purge the cold accumulation. In Rhuharh and Acunite Decoction, asarum herb is cooperated to dispel cold for assuaging pain, so it is applied to constipation due to cold accumulation without deficiency of the middle qi. In Spleen-Warming Decuctiun, dry ginger, ginseng and licorice ruut ure couperatcd to warm yang and to invigorate qi far consolidating the middle-] iao, so it is applied to deficient syndrome complicated by excess, i. c. deficient cold of the spleen and stomach complicated with cold accumulation.
Three Herbs Emergency Pills
san wâ bèi jl san
SOURCE: Synapsis of the C olden Chamber
INGREDIENTS:
Rhubarb 30g
Crnton seed 30g
Dry ginger 30g
DIRECTIONS:Crind the ahove herhs into puwder. Then mix it with honey to make into farm of pills as large as soybean. Taking three or four pills each time. For the case with lockjaw, 1 to 1. 5 gram of the ahove powder could be given by nasal feeding.
EFFECT: Purging the cold accumulatinn.
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INDICATIONS:Sodden attack of distending pain or stabbing pain of cpigastrium and abdomen, even accompanying lockjaw and sudden syncope.
ANALYSIS OF FORMULA: ‘I’his is a drastic formula for porging the acote cold accomolation,which is specially set op for sudden attack of excessive cold accumulation. Being pungent flavor and hot nature crotun seed as the main herb pur ges the cold accumulation drastically. As the assistant herb, dry ginger warms the middle for expelling cold. As the adjovant and dispatcher herb, rhubarb clears gas trointestinal tract and eliminates the toxicity of croton seed.
Because of the toxicity of croton seed which strongly irritates the gastrointestinal tract, this formula cannot ho applied to pregnant woman, aged, feeble persons and as to the case of sudden abdominal pain due to warm or summer-heat evils. If diarrhea is unceasing after taking the pills, cold porridge can stop it.
In the present clinic, this formula has certain curative effects against food poi son, acute simple intestinal obstruction, acute pancreatitis, acute appendicitis pertaining to cold accumulation but with a strong body.
Section 3 Moistening Purgative Formulae
The moistening purgative formulae are suitable for deficient constipation doe to dryness of intestines. There ore two conditions of the deficient coostipstioo: one is the heat evil injuring body fluid, or chronic exuberance of fire with dryness of gastrointestinal tracr which leads to constipation; the other is the deficiency of the kidney yaog or debility after an illness failing to promote the muvement of gastro intestinal tract which can also result in constipation. In both cases the moistening purgation is indicated. For constipation due to iosufficiency of body fluid, the fatriched seeds or kernels such as hemp seed, pine kernel, hitter apricot kernel and peach kernel ore commonly used ss the main herbs to moisten the gastrointestinal tract for relieving constipation. For constipation doe to yang deficiency or qi iosuf ficiency, herbs with warming and moistening functions such as desertliving cistaoche and Chinese angclica rout should he used as the main herbs to relieve cuiistipetiOii .
If it is accompanied by the dry heat of gastrointestinal tract rhubarb can be cooperated to purge heat for relieving constipation; If it is accompanied with qi stagnation, tangerine peel, uuripeoed bitter orange and magnolia bark are usually used together to regulate qi fur relieviog fullness and distention; For the retention uf turlud dampness due to the kidney deficiency, cimicifuga rhizome and water
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plantain could be added to activate the functional activity of qi for assisting relief of constipation. The representative formulae are hemp Seed Pills, Five Kinds of Kernels Pills and Jichoan Decoction.
Five Kinds of Kernels Pills
wit rén wan
SOURCE:Effective Formulae Handed Down for Generations
1NCREDIENTS:
Peach kernel 15g
Bitter apricot kernel 30g
Arborvitae seed 3. 75g
Pine seed 3g
Bosh-cherry seed 3g
Tangerine peel 120g
DIRECTIONS:Grind the above herbs into powder. Then mix it with honey to make into form of pill as large as Chinese parasol seed. fifty pills each time.
EFFECT:Mnistening intestines to relieve constipation.
INDICA’I’IONS:Dryness of intestinal floid manifested by difficulty in defecatinn,and constipation of the aged or due to blood deficiency after delivery.
ANALYSIS OF FORMULA: Thia is a representative formula for moistening intestines to relieve constipation. Except tangerine peel, all the other five herbs are fat riched seeds which can moisten iRtestines to relieve constipation without injo ring the body fluid. Peach and bitter apricot kernels as the main herbs moisten intestines, activate blood and lower qi in the comparatively large dosage. As the assistant herhs, pine, arborvitae, bosh-cherry seeds and honey strengthen the mois tening power. With the largest dosage, tangerins peel activates qi for strengthening spleen, which can prevent the greasiness impeding the stomach qi as well as promoting flow of qi tn relieve constipation. So it is very suitable to constipation due to insufficiency of body floid. But becaose peach kernel can activate blood and clear meridians, bosh cherry is a strong purgative, it should he caotious tn apply this formula to constipatinn of pregnant woman.
If the form of medicine is changed from pills to decoction in clinic, tangerine peel, pine seed and peach kernel shoold be removed and trichosanthes seed and hemp seed should be added. Trichosonthes seed and hemp seed have the comparatively powerful effect on moistening intestines to relieve constipation. Clinically different choices can be chosen based on the disease conditions.
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Hemp Seed Pills
ma zi rfn wan
SOURCE: Treatise on Cold-Attack
INGREDIENTS:
Hemp seed 1 000g
Bitter apricot kernel 500g
Unripened hitter orange 250g
Rhubarb 500g
Magnolia bark 250g
White peony root 250g
DIRECTTONS:Grind the above herbs into powder. Then mix it with honey to make into form of pills as large as Chinese parasol seed. 9 gram of the pills each time.
EFFECT: Moistening intestines to relieve constipation.
INDICATIONS:Dry-heat of gastrointestial tract manifested by constipation, frequent urination, floating and nneven pulse no the part of anterior tibial artery. Hemorrhoids with cunstipatiun.
ANALYSIS OF FORMULA:As tke main herb, hemp seed moistens intestines for relieving constipation. Bitter apricot kernel lowers qi ahd moistens intestines; white peony root nourishes yin and harmonizes the interior. Buth of them act as the assistant herbs. Rhubarb, unripencd bitter orange and magnolia bark(i. e. the Minor Purgative Dccoction) as the ad] uvant herbs purge the dry-heat to eliminate distention and stuffiness as well as relieving constipation. Honey is the dispatcher to assuage the purgative power.
In the present clinic, it is usually applied to constipation sufferred hy the aged and the feeble due to intestinal dryness, or the habitual constipation.
Though this is a moderate purgative formula,it has the defect of breaking qi. So it is not suitable to he often applied to the aged and feeble patients.
jichun Decoction
ii chudn jian
SOURCE: Jingyuc’ s Complete Works
INGREDIENTS:
Chinese angelica root 9’—l5g
Cyathule root 6g
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Desertliving cistanehe 6—’9g
Water plantain 5g
Cimicifuga rhizome I. 53g
Bitter orange 3g
DIRECTIONS:Deeoet the above herba in water for oral administration.
EFFECT: Relieving eonatipation by warming and moistening.
INDICATIONS: Deficiency of the kidney qi marufested hy constipation, clear anne, soreness and weakness in low hack and knees.
ANALYSIS OF FORMULA: Being salt flavor and warm nature, desertliving eistunehe as the main herb tonifies the kidney and essence, moistens the bowel as well to relieve constipation. As the assistant herbs, Chinese angelica root, with pangent flavor and warm nature, naorishes and harmonizes bland as well to moistens the bowel; eyatula root tonifies the. kidney and strengthens tendons. Water plantain can indole diuresis to drain turbidness; hitter orange smoothes intestines and lowers qi; small dosage of eimieifuga rhizome together with water plantain and hitter orange regulate the ascending and descending of qi. They play the role of adjovant and dispatcher herbs.
In Summary
There are totally 9 purgative formulae. Based an their different effects, they are divided into cold purgative formulae, warm purgative formulae and moistening purgative formulae.
1. Cold purgative formulae
All the Major Purgative Deeaetian, Rhubarb and Mautan Bark Deeoetian and Major Deeoetion far Chest Congestion can purge the heat accumulation. The Ma jar Purgative Decoction, with the strongest power of purgation, is the representa— five furmula fur purging heat accumulation drastically, so it is suitable to excessive syndrome of Yangming Jo viscera with stuffiness, fullness, dryness and excessive ness. Rhuharh and Mouton Bark Deeuetian is focused on both purging cold and breaking stasis, so it is mainly applied to intestinal abscess due to stagnation of damp heat. ‘Ihe Major Decoction for Chest Congestion is laid emphasis on purging heat and water, su it is the main formula far treating the blacked up chest syndrome due to coagulation of water and heat in epigastriuro.
2. Warm purgative formulae
All the Rhubarb and Acunite Deeoetian, Spleen Warming l)ecoctiao and Three Herbs Emergency Deeoetion can purge the eald uccumulutiua. Jo the former
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