Zeng Ye Tang (Increase Fluid Decoction)
Author: Li Caiyun
[Original Text]In Yangming warm disease, without upper jiao symptoms, if there is no bowel movement for several days, it should be treated immediately. If the patient has a deficiency of yin, it is not advisable to use Chengqi Decoction; instead, Zeng Ye Tang is indicated. After taking Zeng Ye Tang, observe for 24 hours. If there is still no bowel movement, it can be combined with Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction) for a mild effect. Zeng Ye Tang formula (salty, cold, bitter, sweet method): 1 liang of Yuan Shen (Rehmannia Root), 8 qian of Mai Dong (Ophiopogon), 8 qian of Xi Sheng Di (Raw Rehmannia). Use 8 cups of water, boil down to 3 cups, and if thirsty, drink it all. If still constipated, prepare another dose.[Explanation]In Yangming warm disease, without upper jiao symptoms, if there is no bowel movement for several days, a purgative method should be used for treatment. If the patient has a deficiency of yin fluids, even if there is constipation, Chengqi Decoction should not be used; Zeng Ye Tang should be used instead. After taking Zeng Ye Tang, observe for 24 hours. If there is still no bowel movement, it can be combined with Tiao Wei Cheng Qi Tang for a gentle purgation to harmonize the stomach qi and facilitate bowel movements.The above discusses the conditions in Yangming warm disease where purgation methods can be applied, establishing three treatment methods: for heat accumulation in the intestines and significant yin fluid depletion, Da Cheng Qi Tang (Major Order the Qi Decoction) should be used; for predominant heat in the intestines with less obvious yin fluid damage, Tiao Wei Cheng Qi Tang should be used; for predominant yin fluid depletion with less heat accumulation, Zeng Ye Tang should be used. This emphasizes the importance of preserving body fluids in patients with warm disease when yin fluids are already deficient.[Clinical Application]Zeng Ye Tang has the effect of increasing fluids and moistening dryness, primarily treating Yangming warm disease with deficiency of body fluids and constipation, characterized by hard stools, thirst, dry red tongue, and thin rapid or weak pulse. This condition is due to pathogenic heat depleting body fluids, leading to yin deficiency and dryness, which cannot moisten the intestines. Therefore, it heavily uses Xuan Shen (Scrophularia) which is salty and cold to nourish yin and moisten dryness, Sheng Di (Raw Rehmannia) which is sweet and cold to clear heat and nourish yin, and Mai Dong (Ophiopogon) which is sweet and cold to nourish the lungs and stomach. These three herbs are salty, sweet, bitter, and cold, nourishing yin, increasing fluids, and clearing heat, hence the “salty, cold, bitter, sweet method.” Adjustments: If the deficiency of body fluids and dryness-heat is severe, and after taking Zeng Ye Tang there is still no bowel movement, Da Huang (Rhubarb) and Mang Xiao (Mirabilite) can be added to clear heat and purge, softening hardness and moistening dryness.[Case Studies]1. Case of Meng Jingchun: A 25-year-old female with hard stools, having a bowel movement every 4-5 days, stools are hard, thirsty, with scanty menstruation, normal urination, and normal appetite. Her tongue is red with thin coating, and her pulse is thin and slightly rapid. She previously sought treatment from a warm disease specialist, who prescribed: Sheng Di Huang (30g), Xuan Shen (50g), Mai Dong (30g), Sha Ren (3g), Rou Cong Rong (18g), Gua Lou (60g), Ma Zi Ren (25g), for 7 doses. After ineffective treatment, she consulted Professor Meng Jingchun, reporting no change in symptoms and continued constipation. Professor Meng Jingchun prescribed: Xuan Shen (15g), Sheng Di Huang (12g), Mai Dong (10g), Dang Gui (12g), Rou Cong Rong (20g), Bai Zhu (30g), Hei Zhi Ma (30g), Zhi Zi (20g), Yu Li Ren (15g), Sheng Mai Ya (20g), for 7 doses. Bowel movement occurred once a day, tongue was red and slightly pale, and continued with another 7 doses for follow-up. The prescription was: Xuan Shen (12g), Sheng Di Huang (12g), Dang Gui (12g), Rou Cong Rong (20g), Bai Zhu (40g), Hei Zhi Ma (30g), Zhi Zi (12g), Yu Li Ren (15g), Chao Zhi Qiao (10g), Sheng Mai Ya (20g), Lai Fu Zi (10g), Xing Ren (10g).2. Case of Yang Jin: Treated a patient with habitual constipation for over 10 years, aged 55, presenting with dry mouth, excessive thirst, weight loss, five hearts heat, red tongue with little coating, and symptoms of bowel movement once a week or even longer, with difficult defecation requiring the use of laxatives. Initially, due to typical signs of yin deficiency, Wuren Wan (Five Nut Pill) and Ma Zi Ren Wan (Hemp Seed Pill) were used, but the effect was poor. Later, Zeng Ye Tang was used, but the effect was still not significant, and it was necessary to add Da Huang. Considering that the patient rarely had the urge to defecate and had to strain significantly, it was determined to be a sign of qi deficiency in the intestines. Additionally, considering the patient’s age, kidney qi was also deficient, so 18g of Huang Qi (Astragalus) and 15g of Rou Cong Rong were added to the formula, resulting in good effects without the need for Da Huang to facilitate bowel movements. After continuous treatment for over a month, constipation was basically cured.
Appreciation
