Major Purgative Decoction

Major Purgative Decoction

Rhei Radix et Rhizoma (Da Huang) 4 liang (12g), Magnoliae Officinalis Cortex (Hou Po) 0.5 jin (24g), Aurantii Fructus Immaturus (Zhi Shi) 5 pieces (12g), Natrii Sulfas (Mang Xiao) 3 he (9g)

Da Cheng Qi Tang is prepared as a decoction. Hou po and zhi shi should be decocted first, then da huang added later while it is cooking, and finally dissolve the mang xiao into the strained decoction. The decoction should be taken warm in two divided doses for oral administration. Once loose stool appears, the decoction should be discontinued.

Drastically purges heat accumulation.

1. Excess heat in the yangming fu-organs. The symptoms are constipation with frequent flatulence, gastric stuffiness and abdominal fullness, abdominal pain that feels worse with pressure, and the abdomen is tense and firm when pressed. In severe cases, there may be tidal fever, delirious speech, and profuse sweating from the palms and soles. The tongue coating is dry and yellow with prickles, or dry and parched black with cracks. The pulse is deep and excessive.

The pathogenesis of this pattern is exuberant yangming heat that consumes fluids and dries the stool. Pathogenic heat binds with dry stool to form an excess pattern, which obstructs the qi of the fu-organ. Therefore, the characteristics of this pathomechanism may be simplified as “stuffiness, fullness, dryness, and excess”. Stuffiness refers to the sensation of oppression, obstruction, and heaviness focused in the chest and epigastrium. Fullness refers to distention and fullness of the epigastrium and abdomen that is resistant to palpation. Dryness refers to dry bound stool that accumulates in the intestines causing difficult defecation. Excess refers to the accumulation of heat that has taken form, abdominal pain that is resistant to pressure, constipation, tidal fever, delirious speech, and an excess pulse. When there is watery diarrhea, neither the abdominal fullness nor pain is relieved. When qi stagnation constrains the distribution of yang qi throughout the four limbs, it leads to a pattern called heat inversion. Exuberant heat damages and dries the fluids which causes spasms of tendons and vessels because of the loss of nourishment, which is referred to as convulsive disease. Pathogenic yangming heat rises to disturb the spirit of heart, located above the yangming domain, causing mania. Although all of these manifestations are different, they have the same pathomechanism of severe heat accumulation. It should be treated by drastically purging the heat accumulation in order to prevent the depletion of fluids. This treatment method is described as extracting the firewood from under the cauldron.

1. Da Cheng Qi Tang treats heat retention with watery discharge. If there is watery discharge, why is the purgative method still used?

1. Essential pattern differentiation Da Cheng Qi Tang is the basic formula used to treat yangming bowel excess and the representative formula of cold purgation. This clinical pattern is marked by pi, fullness dryness, excess, red tongue with a yellow coating and deep excess pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of a yangming bowel excess pattern: acute simple intestinal obstruction, adhesive intestinal obstruction, ascaris intestinal obstruction, acute cholecystitis, acute pancreatitis, and incomplete pyloric obstruction; or when the patient shows signs of constipation, a yellow tongue coating, and an excess pulse: hyperpyrexia, unconsciousness, delirious speech, fright syncope, or mania in the course of febrile disease. 3. Cautions and contraindications It is not applicable for patients diagnosed with qi and yin deficiency, slight dryness and stagnation, or for those who are aged and weak. It is forbidden to use for pregnant women. Avoid taking a high dose in order to prevent the zheng qi from being damaged.

1. Xiao Cheng Qi Tang (Minor Purgative Decoction, 小承氣湯)