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Draining-precipitation formulas

泻下剂 〔瀉下劑〕xiè xià jì

Medicinal formulas that stimulate fecal flow to expel repletion evils and remove accumulation and stagnation. They have the actions of freeing the stool, draining heat, attaching accumulation, and expelling water. Draining-precipitant formulas correspond to precipitation among the eight and to draining-precipitant agents among medicinals. Sù Wèn (Chapter 5) states, draw out and exhaust what is low and disperse and draining what is replete.

Draining-precipitant formulas treat interior repletion, but formulas differ considerably interior repletion can take different forms, including heat bind, cold bind, dryness bind, and water bind occurring in patients with differences as regards constitutional vacuity and repletion. For this reason, formulas are divided into four categories, cold precipitation, warm precipitation, moist precipitation, and dispelling water, simultaneous attack and supplementation, as described below.

Cautions

To use draining-precipitant formulas, any exterior evils must have been resolved and interior repletion must have fully formed. If an interior pattern has formed before an exterior pattern has been resolved, then, depending on the severity, the approach is to treat the exterior pattern before the interior pattern, or apply dual resolution of exterior and interior.

If there is static blood, worms, or phlegm turbidity, medicinals that address such conditions must be incorporated into the formula.

In elderly or constitutionally weak patients, pregnant women, postpartum patients, and women currently menstruating, draining-precipitant formulas should be used with care or not used at all.

Draining-precipitant formulas easily damage stomach qì, and hence should be applied only until the desired effect is reached to avoid excessive use. Oily and poorly digestible food should be avoided to prevent damage to stomach qì.

Subcategories

Cold Precipitation Formulas

Cold precipitation formulas are used for interior repletion patterns with accumulation and stagnation in the intestines, manifesting in constipation (hard bound stool), abdominal pain, distension, or fullness, and in severe cases with tidal heat effusion, together with a thick yellow tongue fur and a pulse that is replete.

Main agents

Since interior heat with accumulation and stagnation affects the upbearing and downbearing of stomach and intestine qì, it can cause qì stagnation and even blood stasis, which call for the inclusion of agents that move qì and/or quicken the blood and dispel stasis, such as unripe bitter orange (Aurantii Fructus Immaturus, 枳实 zhǐ shí), magnolia bark (Magnoliae Officinalis Cortex, 厚朴 hòu pò), peach kernel (Persicae Semen, 桃仁 táo rén), and moutan (Moutan Cortex, 牡丹皮 mǔ dān pí).

Representative formulas

Warm Precipitation Formulas

Warm precipitation formulas treat interior cold accumulation and station with constipation, abdominal fullness and distension, abdominal pain the likes pressure, lack of warmth in the extremities, and a pulse that is sunken and replete. Cold cannot be treated without warming, and accumulation cannot be eliminated without precipitation, cold-natured rhubarb (Rhei Radix et Rhizoma, 大黄 dà huáng) must be combined with interior-warming agents such as 附子 fù zǐ) and dried ginger (Zingiberis Rhizoma, 干姜 gān jiāng). In some cases, formulas with croton (Crotonis Fructus, 巴豆 bā dòu) as the main agent can be used.

Representative formulas

Moist Precipitant Formulas

These treat constipation due to intestinal dryness and liquid depletion with short voidings of reddish urine, in some cases genderized heat, dry mouth, abdominal distension, abdominal pain, together with a red tongue with yellow fur and a pulse that is slippery and rapid.

If intestinal dryness constipation is attributable to heat evil damaging liquid or to exuberant constitutional fire with dryness in the stomach and intestines, the agents and formulas to use are as follows:

Main agent: hemp seed (Cannabis Semen, 火麻仁 huǒ má rén) and Apricot kernel (Armeniacae Semen, 杏仁 xìng rén) as the main agents combined with cold precipitating agents.

Representative formulas: Hemp Seed Pill (麻子仁丸 má zǐ rén wán) and Five Kernels Pill (五仁丸 wǔ rén wán)

In patients with kidney qì vacuity or with vacuity that has developed as a result of severe disease, constipation with long voidings of clear urine and weak lumbus and legs can be treated by the warm supplementation and moist stool-freeing action of cistanche (Cistanches Herba, 肉苁蓉 ròu cōng róng) and Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), as in the representative formula Ferry Brew (济川煎 jì chuān jiān).

Water-Expelling Formulas

These treat water-rheum congesting in the interior, manifesting in water swelling and abdominal distension with pain in the chest and rib-side, inhibited urination and defecation, and pulse that is replete and forceful. Formulas used to treat such conditions use drastic water-expelling agents.

Main agents

These agents are hard and toxic, so they are usually combined with right-supporting agents such as Lepidium/Descurainiae and Jujube Lung-Draining Decoction (葶苈大枣泻肺汤 tíng lì dà zǎo xiè fèi tāng).

Because water-rheum hampers the qì dynamic, qì-moving medicinals such as unripe tangerine peel (Citri Reticulatae Pericarpium Viride, 青皮 qīng pí), and tangerine peel (Citri Reticulatae Pericarpium, 陈皮 chén pí), costusroot (Aucklandiae Radix, 木香 mù xiāng), and areca (Arecae Semen, 槟榔 bīng láng) can also be added if necessary according to the principle of that when qì moves, water moves.

Representative formulas

Simultaneous Attack and Supplementation Formulas

Simultaneous attack and supplementation formulas treat constipation with interior repletion with right vacuity manifesting in abdominal fullness together with signs of insufficiency of qì and blood or internal exhaustion of yīn liquid. In such cases, the repletion cannot be eliminated without offensive treatment, the vacuity cannot be addressed without supplementing, so that simultaneous attack and supplementation is used to treat both evil and right is the only course of action. Formulas designed for such conditions include offensive agents like rhubarb (Rhei Radix et Rhizoma, 大黄 dà huáng) and mirabilite (Natrii Sulfas, 芒硝 máng xiāo) combined with supplementing agents such as ginseng (Ginseng Radix, 人参 rén shēn), med>Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), and dried/fresh rehmannia (Rehmanniae Radix, 生地黄 shēng dì huáng).

Representative formulas

See precipitation.

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