1. Class 7-8: Herbs and Formulas That Drain Downward Xianhui Li

2. Herbs Purgative –Radix et Rhizoma rhei (Da huang) –Natrii Sulfas (Mang xiao) –Folium Sennae (Fan xie ye) –Aloe Vera (Lu hui) Moist laxatives –Fructus Cannabis (Huo ma ren) –Semen Pruni (Yu li ren) Harsh expellants –Radix Kansui (Gan sui) –Radix Euphorbiae (Da ji) –Flos Genkwa (Yuan hua)

3. Radix et Rhizoma rhei (Da huang) Taste and Properties: Bitter and cold Meridian tropism: SP, ST, LI, LV, HT Actions: Purge heat, eliminate accumulated pathogens; clear away heat and purge fire; Remove toxic materials; Activate blood flow and remove blood stasis Indications: –For retained food in the intestine and constipation: This is one of the most important herb to treat constipation due to stagnancy, especially for constipation due to accumulated heat. Excess heat with deficiency of both qi and blood. Accumulated heat impairing yin. Constipation due to cold accumulation. –Hematemesis or epistaxis due to blood heat or red eyes, sore throat and swollen and pain of gums. –Carbuncles due to toxic heat or burns. –For patterns due to stagnation of blood: amenorrhea, lochiarrhoea, abdominal mass or traumatic injury. –Jaundice or stranguria due to damp heat. Dosage and Administration: 3-12g. Used raw, decocted later when used in decoction. For purging pathogen. Da Huang, prepared with wine, is weak in purging but strong in activating blood flow, mainly used to blood stasis. Carbonized Da Huang is used for bleeding. Attentions: should not use in those stomach and spleen deficiency. Use with caution during menstruation, pregnancy, and lactation

4. Natrii Sulfas (Mang xiao) Taste and Property: Salty, bitter and cold Meridian Tropism: ST, LI Actions: Purge pathogens, soften hardness, clear heat Indications: –For dry stool due to accumulation of excess heat. –For sore throat, mouth ulcer, red eyes or carbuncles and sores, often used externally, i.e. Bing Peng San, XI Guan Shuang. When it is melt in. –For acute mastitis: External application of Mang Xiao –For stop milk secretion: Used externally Dosage and administration: 10-15g, used by being melt in decoction or boiled water Attention: Not suggested for pregnant woman

5. Folium Sennae (Fan xie ye) Taste and Property: Sweet, bitter and cold Meridian Tropism: LI Actions: Promote bowel movement and eliminate retained substances Indications: –Constipation, especially that caused by excess heat, used usually alone after soaked in water. Small dose can promote bowel movement mildly while the large dose will have a strong purgative effect. Dosage and Administration: 1.5-3g for mild purgative purpose and 5-10g for strong one. Attention: Not suggested for woman at the breast- feeding period, menstrual period and pregnancy. Side Effect: Nausea, vomiting and abdominal pain when used at a large dosage

6. Aloe Vera (Lu hui) Taste and Property: Bitter and cold Meridian tropism: LV LI Actions: Promote bowel movement, clear away liver heat and kill worms Indications: –Habitual constipation or constipation due to excess heat: This herb is good at promoting bowel movement and purging the liver fire, mostly suitable for constipation with restlessness and insomnia. –Constipation with excess heat in the liver meridian marked by dizziness, headache, irritability, epilepsy. –Infantile malnutrition: This herb kills roundworm, used for malnutrition marked by sallow complexion, abdominal pain and emaciation due to parasites. –Tinea when used externally Dosage and Administration: 1-2g. Used only in the form of pills or powder Attentions: Not suggested for patients with deficiency cold of the spleen and the stomach marked by poor appetite and loose stool, and pregnant woman

7. Fructus Cannabis (Huo ma ren) Taste and Property: Sweet and neutral Meridian tropism: LI SP ST Actions: moistens the intestine; nourishes yin; clears heat and promotes healing of sores Indications: –For constipation in the elderly, in the aftermath of a febrile disease, postpartum, and incases of blood deficiency. –Mildly tonifies yin and primarily used in case of yin deficiency with constipation. –As an auxiliary herb for sores and ulcerations, taken orally or applied topically Dosage and Administration: 9-15g crush before decocting Attentions: over dose can lead to nausea, vomiting, and diarrhea

8. Semen Pruni (Yu li ren) Taste and Property: Acrid, bitter, sweet and neutral Meridian tropism: LI SI SP Actions: moistens the intestine; promotes urination and reduces edema Indications: –For constipation due to dryness of the intestines. –For leg qi or edema with urinary difficulty and constipation. Dosage and Administration: 3-9g crush before decocting Attentions: use with caution during pregnancy

9. Radix Kansui (Gan sui) Taste and Property: Bitter, sweet, cold and toxic Meridian Tropism: LU KI LI Actions: Purge water to eliminate retained fluid, Subdue swelling and dissipate nodules Indications: –Edema of face and body, ascites or pleural effusion This herb has a very strong hydragogues effect which may cause continuous diarrhea to eliminate the water. –Epilepsy due to wind phlegm: This is based on the phlegm-eliminating effect of the herb. –Carbuncles or furuncles: External application of the powder of Gan Sui with water Dosage: This herb should be made into pills or powders because the effective ingredients is not water-soluble, 0.5-1g. The toxicity can be reduced when prepared with vinegar Contraindications: Not suggested for weak patients or pregnant woman. Can not be used together with Gan Cao.

10. Radix Euphorbiae (Da ji) Taste and Property: Bitter, pungent, cold and toxic Meridian Tropism: LU KI LI Actions: Purge water to eliminate retained water; Subdue swelling and dissipate nodules Indications: –Edema of face and body. This herb has a similar effect with Gan Sui in eliminating water, although it is weaker. –Carbuncles or scrofula due to toxic heat or accumulated phlegm and fire. Dosage: 1.5-3g. Prepared with vinegar to reduce the toxicity Contraindications: Not suggested for weak patients or pregnant woman, Can not be used together with Gan Cao.

11. Flos Genkwa (Yuan hua) Taste and Property: Pungent, bitter, warm, toxic Meridian Tropism: KI LU LI Actions: Purge water to eliminate retained fluid; eliminate phlegm to relieve cough; kill worms and treat carbuncles Indications: –Edema or retained fluid in the abdomen, pleural cavity. It has a similar water-purging effect as Gan Sui and Da Ji, but it is more good at purging water in the chest or pleural region. In can be used to treat chronic bronchitis due to cold dampness –Skin fungus when used externally Dosage: 1.5-3g. Contraindications: Not suggested for weak patients or pregnant woman, Can not be used together with Gan Cao.

12. Formulas that Purge Heat Accumulation –Major Order the Qi Decoction (da cheng qi tang) FS: p115 –Minor Order the Qi Decoction (xiao cheng qi tang) FS: p117 –Regulate the Stomach and Order the Qi Decoction (tiao wei cheng qi tang) FS: p117 Formulas that Moisten the Intestines and Unblock the Bowels –Hemp Seed Pill (ma zi ren wan) FS: p123 –Moisten the Intestines Pill from Master Shen's Book (run chang wan) FS: p125 –Benefit the River [flow] Decoction (ji chuan jian) FS: p125 Formulas that Warm the Yang and Guide Out Accumulation –Rhubarb and Prepared Aconite Decoction (da huang fu zi tang) FS: p126 Formulas that Drive Out Excess Water –Ten-Jujube Decoction (shi zao tang) FS: p128

13. Major Order the Qi Decoction (da cheng qi tang) Ingredients: da huang, mang xiao, zhi shi, hou po

14. Actions and indications of the formula Actions –Vigorously purges heat accumulation. Indications –Severe constipation and flatulence, focal distention and abdominal fullness, abdominal pain which increases upon pressure, a tense and firm abdomen, a dry, yellow or dry, black tongue coating with prickles, and a submerged, excessive pulse. In severe cases, there may be tidal fevers, delirious speech, and profuse sweating from the palms and soles.

15. Analysis of Formula Chief: da huang –purges heat accumulation Deputy: mang xiao –Clears heat and softens stools Assistant: zhi shi, hou po –Zhi shi: dissipates clumps and reduces focal distention –Hou po: disseminates the qi and relieves the sensation of fullness

16. Modern application and modifications Modern application: –Disorders as acute uncomplicated appendicitis, acute cholecystitis, acute pancreatits, uncomplicated interstinal obstruction, postoperative constipation and distention, roundworm in the bile duct, early-stage dyentery, and pneumonia Attentions: –Contraindicated during pregnancy. Be careful for weak patients Modifications: –For severe abdominal distention, add lai fu zi. –For signs of blood stasis, add tao ren, chi shao.

17. Minor Order the Qi Decoction (xiao cheng qi tang) Ingredients: da huang, hou po, zhi shi

18. Actions and indications of the formula Actions –Moderately purges heat accumulation. Indications –For relatively mild yang brightness organ- stage disorders characterized by tidal fever, constipation, focal distention, and abdominal fullness, abdominal pain that does not increase upon pressure, an old-looking (dirty and dry), yellow tongue coating, and a slippery, rapid pulse. Also for early-stage dysenteric disorders.

19. Regulate the Stomach and Order the Qi Decoction (tiao wei cheng qi tang) Ingredients: da huang, mang xiao, gan cao

20. Actions and indications of the formula Actions –Mildly purges heat accumulation. Indications –For mild constipation due to yang brightness- stage heat characterized by no focal distention and no abdominal fullness, but with irritability and a slippery, rapid pulse. Also for nosebleed, swollen gums and swollen throat, and petechiae (subcutaneous bleeding) due to heat in the Stomach and Intestines.

21. Hemp Seed Pill (ma zi ren wan) Ingredients: huo ma ren, xing ren, shao yao, zhi shi, hou po, da huang

22. Actions and indications of the formula Actions –Moistens the intestines, drains heat, promotes the movement of qi, and unblocks the bowel. Indications –Constipation with hard stool that is difficult to expel, frequent urination, a dry, yellow tongue coating, and submerged, rapid or floating, choppy pulse.

23. Analysis of Formula Chief: huo ma ren –Moistens the intestines and unblocks the bowels Deputy: xing ren, bai shao –Xing ren: directs qi downward and moistens the intestines –Bai shao: nourishes yin and harmonizes the interior Assistant: zhi shi, hou po, da huang –Zhi shi: breaks up accumulation –Hou po: removes fullness and distention –Da huang: purges down Envoy: honey –Used as a medium in forming the pills, it also moistens the intestine

24. Modern application and modifications Modern application: –Disorders as habitual, post partum, or post-surgical constipation, and hemorrhoids Attentions: –Contraindicated during pregnancy. Be careful for weak patients. Modifications: –For severe injury to the fluids, add bai zi ren, gua lou ren –For severe heat accumulation with a yellow tongue coating and a rapid pulse, increase the dosage of da huang, add mang xiao –For deficiency of the middle qi, take with bu zhong yi qi tang

25. Moisten the Intestines Pill from Master Shen's Book (run chang wan) Ingredients: huo ma ren, tao ren, dang gui, sheng di huang, zhi ke

26. Actions and indications of the formula Actions –Moistens the intestines and unblocks the bowels. Indications –Constipation, lusterless skin and nails, dry mouth with an unquenchable thirst, a dry tongue, and a thin pulse.

27. Analysis of Formula Chief: huo ma ren, tao ren –Moisten the intestines and unblock the bowels Deputy: dang gui, sheng di huang –Dang gui: nourishes and harmonizes the blood and moistens the intestines –Sheng di huang: nourishes yin Envoy: zhi ke –Reinforces the laxative effect of the formula, and prevents the cloying nature of the other herbs from injuring the spleen and stomach

28. Modern application and modifications Modern application: –Disorders as post partum and habitual constipation Modifications: –For heat signs, add zhi mu, yu zhu

29. Benefit the River [flow] Decoction (ji chuan jian) Ingredients: rou cong rong, dang gui, niu xi, ze xie, zhi ke, sheng ma

30. Actions and indications of the formula Actions –Warms the kidneys, moistens the intestines, and unblocks the bowels. Indications –Constipation, clear and copious urine, lower back pain, and a cold sensation in the back.

31. Analysis of Formula Chief: rou cong rong –Warms and tonifies the kidney yang, warms lower back, and mostens the intestiens to unblock the bowels Deputy: dang gui, niu xi –Dang gui: nourishes and harmonizes the blood and moistens the intestines –Niu xi: strengthens the lower back and kidneys Assistant: –Ze xie: descending nature which drains turbidity from the kidneys and preventing the chief herb from causing stagnation Envoy: –Zhi ke: relaxes the intestines and directs the qi downward and unblocks the bowels –Sheng ma: raises clear yang as a subtle inducement to descent of the turbid yin

32. Modern application and modifications Modern application: –Disorders as atonic constipation, degenerative joint disease, an chronic arthritis Modifications: –For pronounced qi deficiency, add ren shen –For fire, add huang qin –Fro severe kidney deficiency, add shu di huang.

33. Rhubarb and Prepared Aconite Decoction (da huang fu zi tang) Ingredients: da huang, fu zi, xi xin

34. Actions and indications of the formula Actions –Warms the interior, disperses cold, unblocks the bowels, and alleviates pain. Indications –Abdominal pain, constipation, hypochondria pain, chills, low-grade fever, cold hands and feet, a white, greasy tongue coating, and a submerged tight, and wiry pulse.

35. Analysis of Formula Chief: fu zi –Warms the yang and dispels cold Deputy: da huang –Cleanses the intestines and purge stagnant accumulation. It also enters the liver channel in the blood level and treats hypochondriac pain Assistant: xi xin –Expels cold and disperses accumulation or clump

36. Modern application and modifications Modern application: –Disorders as chronic dysentery, uremia, ulcerative colitis, uncomplicated appendicitis, and uncomplicated intestinal obstruction Modifications: –For severe abdominal pain, add gui zhi, bai shao. –For severe distention and a thick, dirty tongue coating, add zhi shi, shen qu. –For general debility or rather mild accumulation, use zhi da huang. –For cold hernial disorders with severe back and groin pain, add rou gui, xiao gui xiang.

37. Ten-Jujube Decoction (shi zao tang) Ingredients: Da zao, gan sui, da ji, yuan hua

38. Actions and indications of the formula Actions –Purges and drives out congested fluids. Indications –Cough with pain in the chest and hypochondria, hard focal distention in the epigastrium, dry heaves, shortness of breath, headache, vertigo, a white, slippery tongue coating, and a submerged, wiry pulse. May also be chest pain extending to the back that makes breathing difficult.

39. Analysis of Formula Gan sui: expels fluids and dampness from the channels Da ji: drains fluids and dampness from the organs Yuan hua: reduces and eliminates congested fluids from the chest and hypochondria Da zao: augment the qi, protects stomach, and moderates the harshness and toxicity of the other ingredients

40. Modern application and attentions Modern application: –Disorders as exudative pleurisy, uremia from systemic lupus erythematosus, nephrotic syndrome and ascites from cirrhosis Attentions: –This formula should be used with extreme caution in weak or pregnant patients. If severe diarrhea occurs, cold rice porridge should be taken. In cases with weakness, cold rice porridge should be taken. In cases with weakness, this formula should be taken in turn with another that strengthens the spleen and augments the qi: one purges while the other tonifies.