There are three formulas in the ‘Drain Downwards’ category:
Formulas that Purge Heat Accumulation
- Da Cheng Qi Tang (Major Order the Qi Decoction)
- Xiao Cheng Qi Tang (Minor Order the Qi Decoction)
Formulas that Moisten the Intestines & Unblock the Bowels
- Ma Zi Ren Tang (Hemp Seed Pill)
1. Da Cheng Qi Tang (Major Order the Qi Decoction)
[copy2cart name=”Da Cheng Qi Tang (Major Order the Qi Decoction)” formula=”DHG(6 – 12)|MXO(9 – 12)|ZSI(12 – 15)|HPO(12 – 15)” mode=”2″]
| Da Huang | 6 – 12 | Radix et Rhizoma Rhei |
| Mang Xiao* | 9 – 12 | Mirabilitum* |
| Zhi Shi | 12 – 15 | Fructus Immaturus Citri aurantii |
| Hou Po | 12 – 15 | Cortex Magnoliae officinalis |
Actions
Vigorously purges Heat accumulation
Clears Yang-Ming (Brightness) Organ-Stage Disorders
Indications
- Severe constipation and flatulence
- Focal distension and abdominal fullness
- A tense, firm, painful abdomen and the pain is worse for pressure
- Severe cases can involve tidal fevers, delirium and profuse sweating from the palms and soles
- A dry, yellow or dry black tongue coating with prickles
- A deep, forceful pulse
Formula
- Da Huang (chief) bitter & cold and purges the intestines.
- Mang Xiao (deputy) salty & cold, softens the stool.
- Zhi Shi (assistant) dissipates clumps and reduces focal distension.
- Hou Po (assistant) spreads the Qi and relieves fullness, with both assistants moving Qi to help expel the stool.
Adaptations
- High fever, severe thirst and a rapid, forceful pulse (Yang-Ming organ & channel stage disorder): add Zhi Mu and Hua Shi
- Severe abdominal distension: add Lai Fu Zi
- Signs of Blood stasis: add Chi Shao and Tao Ren
Discussion
- This formula is for Yang-Ming (Brightness) Organ-Stage disorders where excess Heat accumulates in the Stomach and Intestines, where it injures fluids and forms clumps that obstruct the downward flow of Qi.
- Yang-Ming organ stage is different to Yang-Ming channel stage, where the heat should be cleared rather than drained downwards.
- It is also used for Lesser(Shao)-Yin Stage disorders (feeling of heat, night sweats, dark urine, insomnia, irritability).
- With the appropriate presentation, this formula may be used to treat acute uncomplicated appendicitis, acute cholecystitis, acute pancreatitis, uncomplicated intestinal obstruction, early-stage dysentery and pneumonia (especially in children).
Cautions & Contraindications
- This formula should be discontinued once diarrhoea has been induced.
- It should be used with great caution with weak patients as it can cause vomiting and severe diarrhoea.
- Contraindicated in pregnancy.
2. Xiao Cheng Qi Tang (Minor Order the Qi Decoction)
[copy2cart name=”Xiao Cheng Qi Tang (Minor Order the Qi Decoction)” formula=”DHG(12)|HPO(6)|ZSI(6 – 9)” mode=”2″]
| Da Huang | 12 | Radix et Rhizoma Rhei |
| Hou Po | 6 | Cortex Magnoliae officinalis |
| Zhi Shi | 6 – 9 | Fructus Immaturus Citri aurantii |
Actions
Purges Yang-Ming Stage Organ Heat
Indications
- Tidal fever, constipation, focal distension and abdominal fullness
- A painful abdomen which is not worse for pressure
- A dirty, dry yellow tongue coating
- A slippery, rapid pulse
For relatively mild Yang-Ming organ-stage, disorders, or for early-stage dysenteric disorders
Formula
- Da Huang (chief) bitter & cold and purges the intestines.
- Hou Po (deputy) spreads the Qi and relieves fullness, and with Zhi Shi moves Qi to help expel the stool.
- Zhi Shi (assistant) dissipates clumps and reduces focal distension.
Cautions & Contraindications
This formula should be discontinued once diarrhoea has been induced
Contraindicated in pregnancy
3. Ma Zi Ren Tang (Hemp Seed Pill)
[copy2cart name=”Ma Zi Ren Tang (Hemp Seed Pill)” formula=”HMR(9 – 15)|XRN(3 – 6)|BSY(3 – 6)|ZSI(3 – 6)|HPO(3 – 6)|DHG(3 – 9)” mode=”2″]
| Huo Ma Ren | 9 – 15 | Semen Cannabis;Fructus Cannabis |
| Xing Ren | 3 – 6 | Semen Armeniacae Amarum |
| Bai Shao | 3 – 6 | Radix Paeoniae lactiflorae |
| Zhi Shi | 3 – 6 | Fructus Immaturus Citri aurantii |
| Hou Po | 3 – 6 | Cortex Magnoliae officinalis |
| Da Huang | 3 – 9 | Radix et Rhizoma Rhei |
Actions
Moistens the Intestines, drains Heat, Promotes Qi movement and unblocks the bowels
Indications
- Constipation with hard stools that are difficult to expel
- Frequent urination
- A dry, yellow tongue coating
- A deep and rapid or floating and choppy pulse
Formula
- Huo Ma Ren (chief) moistens the Intestines and unblocks the bowels.
- Xing Ren (deputy) directs Qi downwards and moistens the Intestines.
- Bai Shao (deputy) nourishes the Yin and harmonises the Interior.
- Zhi Shi (assistant) breaks up accumulation, especially in the Intestines.
- Hou Po (assistant) removes fullness and distension.
- Da Huang (assistant) is cold and bitter and purges the Intestines.
Adaptations
- Severe injury to the fluids: add Bai Zi Ren and Gua Lou Ren
- Severe Heat accumulation with a yellow tongue coating and a rapid pulse: increase Da Huang dose and add Mang Xiao
- Severe debility: omit Da Huang and add a small amount of Fan Xie Ye (senna)
- Haemorrhoids: add Tao Ren and Dang Gui
- Bleeding haemorrhoids: add Huai Hua Mi and Di Yu
- Spleen Qi deficiency: take with Bu Zhong Yi Qi Tang
Discussion
- This is a modification of Xiao Cheng Qi Tang, with the addition of herbs that nourish and moisten.
- With the appropriate presentation, it may be used for habitual, post-partum or post-surgical constipation and haemorrhoids.
Cautions & Contraindications
- Most of the herbs in the formula have draining, dispersing or purgative properties, making it inappropriate for very weak patients or constipation due to Blood deficiency.
- Contraindicated in pregnancy.