1. Cold Purgation

1. Cold Purgation

Cold purgative formulas have the effect of clearing heat and attacking excess, suitable for syndromes of internal accumulation of real heat. Symptoms include severe constipation, fullness and pain in the epigastric region, sometimes accompanied by tidal fever and delirium, a charred yellow tongue coating, and a slippery, full pulse. This formula can also be used for intestinal abscesses caused by accumulation of damp-heat and stagnation of qi and blood.

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1. Da Cheng Qi Tang from "Shang Han Lun"

[Composition] Rheum palmatum 9 grams (four liang), Magnolia officinalis 6 grams (eight liang, peeled and roasted), Citrus aurantium immaturus 9 grams (five pieces, roasted), Glauber's salt 15 grams (three he).

[Administration] First boil Citrus aurantium and Magnolia officinalis in water, remove the residue, add Rheum palmatum, boil again and remove the residue, then add Glauber's salt, bring to a gentle boil for one to two minutes, and take in divided doses while warm.

[Indications] Yangming organ excess (internal accumulation of real heat).

After repeating this process twice, the stubborn fluid remained deeply rooted, and the medicinal power was insufficient, so another dose of the original formula was administered. The next day, after taking the medicine, the patient felt even more frustrated and restless than before. Thirty minutes after eating, the patient suddenly vomited several bowls of clear water, after which all symptoms subsided. A follow-up half a month later showed that the abdominal distension had disappeared and bowel movements were normal, with complete recovery. ("New Chinese Medicine," May 1974, p.31)

[Commentary] With modifications, this formula can treat exudative pleurisy, intestinal obstruction, and peritonitis.

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4. Shi Zao Tang from "Shang Han Lun"

For frail individuals, take 1.5 grams in the early morning while warm; if the condition does not improve after one dose, increase the amount by 0.5 grams the next day, taking it on an empty stomach in the morning.

[Indications] Suspended phlegm.

[Symptoms] Coughing and spitting causing pain, chest, back, and flank pain, epigastric fullness and distension, dry heaving and shortness of breath, headache and dizziness, and a deep, string-like pulse.

[Functions] Expel water retention.

[Explanation] According to "Jin Gui Yao Lue," "When phlegm accumulates beneath the ribs after drinking, coughing and spitting cause pain, which is referred to as suspended phlegm." It is evident that suspended phlegm arises from the accumulation of phlegm beneath the ribs. When phlegm accumulates, it causes pain during coughing and spitting, as well as chest and back pain, and epigastric fullness and distension; when phlegm rises upward, it leads to dry heaving, shortness of breath, headache, and dizziness. In this formula, Euphorbia kansui excels at moving phlegm through the meridians, Euphorbia pekinensis effectively drains water and dampness from the internal organs, and Flos farfarae eliminates phlegm and water in the chest. All three herbs are potent purgatives that move water and dampness, and when used together, they can eliminate even stubborn phlegm and water despite their strong nature. However, these three herbs are extremely harsh and slightly toxic, easily damaging vital energy; therefore, Jujube is added to strengthen the spleen and support vital energy, ensuring that the spleen remains robust and capable of dispersing phlegm and dampness. With sufficient vital energy, the harsh ingredients become harmless. The name "Ten Dates" emphasizes the importance of supporting vital energy, with the ten dates serving as auxiliary herbs, while Euphorbia pekinensis, Euphorbia kansui, and Flos farfarae are the main active ingredients.

[Clinical Modifications] ① Remove Flos farfarae and add white mustard seeds, forming Kong Yan Dan ("Three Causes Formula"). Treats phlegm.

When phlegm accumulates above and below the heart and diaphragm, sudden chest and back pain occurs, along with unbearable aching in the hands, feet, neck, and lower back. ② Remove Jujube and add green peel, dried tangerine peel, agarwood, betel nut, black nightshade, Rheum palmatum, and light powder, forming Zhou Che Wan (Liu Hejian). Treats edema and water swelling, with both physical and spiritual manifestations, severe constipation, and a deep, powerful pulse.

[Reference Materials] ① Li Shizhen said: When Zhang Zhongjing treated solar syndrome in Shang Han, if the exterior was not yet resolved and there was water in the epigastric region causing coughing, dry heaving, fever, or wheezing and diarrhea, Xiao Qing Long Tang was the primary prescription; if the exterior had been resolved and there was still headache and chills, water in the epigastric region, dry heaving, pain radiating to both flanks, or wheezing and coughing, Shi Zao Tang was the primary prescription. ("Cheng Fang Qie Yong") ② Shi Zao Tang was used to treat 51 cases of exudative pleurisy, with satisfactory results. All 51 cases were confirmed by X-ray to have pleural effusion, and the Shi Zao Tang used involved grinding Euphorbia pekinensis, Flos farfarae, and Euphorbia kansui into fine powders (preferably in powder form) for administration, along with decocting 10–15 Jujubes to obtain 300 ml of juice. The administration method was to take half of the Jujube decoction on an empty stomach at 10 a.m., followed five minutes later by the powdered herbs mixed with the Jujube decoction, repeated every other day, generally for 4–6 doses. The results showed that 96% of patients experienced improvement in pleural effusion within eight days, 88.2% saw complete disappearance within 20 days, with an average time of 16.2 days for effusion to disappear, and a small number of cases still experienced residual chest pain after the effusion was absorbed. ("Fujian Journal of Traditional Chinese Medicine," June 1965, p.43) ③ Shi Zao Tang was also effective in treating systemic lupus erythematosus complicated by uremia, nephrotic syndrome, rheumatoid arthritis, schizophrenia, and other conditions. When administering, strictly adhere to Zhang Zhongjing’s method: grind the three herbs into fine powders, take them on an empty stomach in the morning without making a decoction. ("Liaoning Journal of Traditional Chinese Medicine," December 1980, p.25)

[Commentary] ① This formula is extremely harsh and toxic; when administering, start with a small dose (0.5–1 gram) and gradually increase it. If, after purging, the water has not completely drained and the patient still feels well enough to continue, another dose may be given; however, if the patient feels exhausted and has lost appetite after purging, even if the water has not fully drained, administration should be stopped. Observe for 1–2 days, then decide based on the patient’s specific condition. ② Besides exudative pleurisy, this formula can also be used for tuberculous peritonitis, ascites due to liver cirrhosis, and edema associated with chronic nephritis.

2. Warm Purgation

Warm purgative formulas have the effect of dispersing cold and removing stagnation, suitable for syndromes of cold congealing and stagnation. Common symptoms include abdominal distension, preference for warmth in relieving pain, and severe constipation. Cold congealing cannot be dispersed without warming, and stagnation cannot be eliminated without purging; therefore, warm purgation is employed.