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Source: Shāng Hán Lùn 伤寒论

Ingredients:

• Dà huáng (大黄 Rhei Radix et Rhizoma, rhubarb) (add at end) 12g
• Máng xiāo (芒硝 Natrii Sulfas , mirabilite) (drenched) 9g
• Hòu pò (厚朴 Magnoliae Officinalis Cortex, officinal magnolia bark) 15g
• Zhǐ shí (枳实 Aurantii Fructus Immaturus, unripe bitter orange) 15g

Action: Precipitates heat bind; drains fire and resolves toxin.

Indication: Yáng brightness bowel repletion patterns with constipation due to exuberant heat, abdominal fullness and distension with pain exacerbated by pressure, vexation and agitation, and delirious speech. Tongue: Prickly with burnt yellow fur. Pulse: Sunken, replete, and forceful. Also specifically indicated for heat bind with circumfluence (rè jié páng liú, thin foul-smelling diarrhea that forces its way around the blockage), and tetanic reversal.

Category: Draining-precipitation formulas / Cold precipitation formulas

Method: Decoct with water and take warm.

Rationale: Dà huáng eliminates heat and frees the stool; it thus eliminates the cause of disease and the main sign. As modern research shows, it stimulates peristalsis, which explains why it frees the stool. However, it is less effective in softening hardness. For this reason, it is combined with Máng xiāo, which causes the intestines to fill up with a hypertonic saline solution that loosens the stool, helping it to be discharged from the body. Thus, Dà huáng and Máng xiāo are mutually complementary in their action. Hòu pò and Zhǐ shí move qì and eliminate fullness, helping the Dà huáng and Máng xiāo to flush out the accumulation.

Variations:

• Severe qì distension or abdominal fullness: Add Lái fú zǐ (莱菔子 Raphani Semen, radish seed) and Mù xiāng (木香 Aucklandiae Radix, costusroot).
• Accumulated fluid in the abdomen, add Gān suì (甘遂 Kansui Radix, kansui [root]) and Yuán huā (芫花 Genkwa Flos, genkwa [flower]).
• Dry stool and abdominal pain: Increase the Máng xiāo (芒硝 Natrii Sulfas , mirabilite) and Guā lóu zǐ (瓜蒌子 Trichosanthis Semen, trichosanthes seed).
• Enduring dry bind with damage to liquid: Add Tiān huā fěn (天花粉 Trichosanthis Radix, trichosanthes root) and Huǒ má rén (火麻仁 Cannabis Fructus, cannabis fruit).

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