大承气汤

nullCold Purgative Prescriptions Cold Purgative Prescriptions This group of recipes chiefly consists of cold-natured herbs with the effects of purging away heat and relieving constipation. It is associated with the treatment of excess syndrome of internal heat.nullda cheng qi tang Source: Discussion of Cold-induced Disorders (Shang han lun) Major Order the Qi Decoction nullThis formula treats heat accumulation in the Stomach and Intestine by carrying the Stomach qi downward, thereby forcing open the obstruction to the orderly flow of qi. 'Major' indicates that it is the strongest of the formulas in this group.nullIngredients Dahuang 12g Houpo 24g Zhishi 12g Mangxiao 9g nullPreparation The source text advises to cook zhi shi and hou po in ten cups of water until five cups remain and then add da huang and continue cooking until two cups remain. mang xiao is added to the strained decoction which is then brought to a boil. Today it is prepared as a decoction with the ingredients. Once diarrhea has been induced, the use of this formula should be discontinued.nullActions Drastic purgation for eliminating heat retentionnullIndications 1 Yangming fu - organ excess syndrome nullSymptomsSevere constipation and flatulence focal distention and abdominal fullness abdominal pain which increases upon pressure, a tense and firm abdomen, Tongue:dry, yellow or dry, black tongue coating with prickles Pulse:submerged, excessive pulse. tidal fevers, delirious speech, persistent profuse sweating from the palms and soles. nullIndications 2 Heat retention with watery discharge syndrome. nullSymptomswatery stool blue in color, foul flatus abdominal pain, palpable hard lump in it dry mouth and tongue Pulse: slippery rapid nullIndications 3 Heat syncope, convulsive disease or mania due to excess syndrome of interior heat nullThis is a yang brightness organ-stage disorder which is characterized by heat accumulating in the interior and taking form. This heat can be due to externally-contracted cold that transforms into heat, or to externally-contracted heat. When heat enters this stage it injures the fluids, which cause the stool to dry out. The heat and dry stool then combine to form clumps, which obstruct the orderly, downward movement of qi through the Intestines. This results in severe constipation and flatulence, focal distention, a sensation of fullness in the abdomen, and the other abdominal symptoms mentioned.nullThese symptoms can also be viewed as four types of abdominal disharmony: focal distention, fullness, dryness, and hardness. Focal distention refers to the sensation of obstruction and heaviness which is focused in the epigastrium. Fullness refers to the visible distention which is resistant to palpation. Dryness refers to the dry stool which accumulates in the Intestines. Hardness refers to the heat which accumulates and takes form resulting in constipation and abdominal pain that increases upon pressure.nullThe other signs and symptoms are associated with severe heat. Upward-blazing interior heat disturbs the spirit and causes delirious speech. Tidal fever, because the qi in the yang brightness level of the body is strongest during 3-7pm, it is then that the body's normal qi and the pathogenic influence struggle for dominance; hence the fever is strongest during this time. Heat in the yang brightness stage can transform the fluids into steam, which is forced out as profuse sweating through the palms and soles. This has been interpreted to mean that A dry, yellow tongue coating indicates dryness in the interior. In severe cases the coating will become black with prickles. Heat retention also accounted for the submerged, excessive pulse. nullfocal distention fullness dryness hardnessnullda huangbitter in flavour and cold in property Purges heat and relieves constipationchief herb ANALYSIS OF FORMULAnullmang xiao salty in flavour and cold in nature moisten the dryness, soften hard mass and purging heat It is used in combination with da huang to reinforce its effect of drastic purgationdeputy herbnullzhi shi hou po assistants herbsPromote qi circulation, dissipate clump, relieve fullness and distensionCombination of the prescriptionCombination of the prescriptionda huang and mang xiao —strong purgation zhi shi and hou po — promote qi, relieve fullness and distensionCOMMENTARYCOMMENTARYThe principal pattern for which this formula is indicated includes focal distention, abdominal fullness, dry stool, and symptoms of excess. Although the formula is mentioned nineteen times in Discussion of Cold-induced Disorders for a variety of conditions, it is most frequently discussed in connection with this pattern. Nonetheless, it can also be used for early-stage heat collapse with fever, cold extremities, thirst, sweating from the head, constipation, scanty and dark urine, disorientation, delirious speech, a hot sensation in the sternum and epigastrium, and an excessive pulse. nullAlthough indications vary considerably, each of these presentations shares the same underlying mechanism: heat excess accumulating in the Stomach and Intestines where it injures the fluids and forms clumps that obstruct the downward flow of qi. Following the same rationale, some practitioners use this formula to treat closed-type wind-stroke. nullAll of the formulas that 'order the qi' use da huang to cleanse heat accumulation from the Stomach and Intestines. da cheng qi tang, the strongest of the group, treats focal distention, fullness, dryness, and hardness. xiao cheng qi tang, not as strong as the former, treats focal distention, fullness, and hardness without dryness. tiao wei cheng qi tang, which has the mildest purgative action, treats cases without focal distention or fullness.nullWith the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as acute uncomplicated appendicitis, acute cholecystitis, acute pancreatitis, uncomplicated intestinal obstruction, postoperative constipation and distention, roundworm in the bile duct.nullCautionsThis is a very strong formula which may cause severe diarrhea. For weak patients, it should be used only when absolutely necessary, and then with the addition of tonic herbs. Contraindicated during pregnancy.nullMODIFICATIONS For high fever, severe thirst, and a rapid and forceful pulse (a concurrent yang brightness channel and organ-stage disorder), add zhi mu and shi gao. For severe abdominal distention, add lai fu zi. For signs of blood stasis, add tao ren and chi shao. ASSOCIATED FORMULAS ASSOCIATED FORMULAS Minor Order the Qi Decoction xiao cheng qi tangnullda huang 12g hou po 6g zhi shi 6g Ingredients nullCook in four cups of water until slightly over two cups remain, and take in two divided doses. Moderately purges clumped heat. For relatively mild yang brightness organ-stage disorders characterized by tidal fever, constipation, focal distention, abdominal fullness, an 'old-looking' (dirty and dry) yellow tongue coating, and a slippery, rapid pulse. Three-Substance Decoction with Magnolia Bark hou po san wu tangThree-Substance Decoction with Magnolia Bark hou po san wu tangnullhou po 24g zhi shi 12g da huang 12g Ingredients nullCook the first two ingredients in approximately 12 cups of water until five cups remain. Then add the last herb, cook until three cups remain, and take in three divided doses. Drains qi downward and unblocks the bowels. For qi stagnation causing constipation and unremitting pain and fullness in the epigastrium and abdomen.Regulate the Stomach and Order the Qi Decoction tiao wei cheng qi tangRegulate the Stomach and Order the Qi Decoction tiao wei cheng qi tangnullda huang 12g gan cao 6g mang xiao 9g Ingredients nullCook da huang with gan cao, and dissolve mang xiao in the strained decoction. Mildly purges clumped heat. For mild constipation due to yang brightness-stage heat characterized by the absence of focal distention and abdominal fullness, but with a slippery, rapid pulse. Also for nosebleed, swollen gums and throat, and petechiae (subcutaneous bleeding) due to heat in the Stomach and Intestines.