Main Formula for Treating Deficiency of Body Fluids and Constipation

Chinese Medicine Book Club Issue 2751

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Introduction: The Zeng Ye Tang (增液汤, Increase Fluid Decoction) has the effect of increasing fluids and moistening dryness, primarily treating Yangming warm disease and deficiency of body fluids leading to constipation, characterized by hard stools, thirst, and a dry red tongue. Patients with deficiency of body fluids and constipation can choose this formula for treatment. (Editor/Tang Yichao)

Zeng Ye Tang

Author/Li Caiyun

[Original Text] In Yangming warm disease, if there are no symptoms in the upper jiao and the patient has not had a bowel movement for several days, one should use purgative methods. However, if the patient has a deficiency of Yin, one should not use Chengqi Decoction but rather Zeng Ye Tang. After taking Zeng Ye Tang, observe for 24 hours; if there is still no bowel movement, combine it with Tiao Wei Cheng Qi Tang (调胃承气汤, Regulate the Stomach and Purgative Decoction) for a gentle effect. The formula for Zeng Ye Tang (salty, cold, bitter, sweet method): 1 liang of Yuan Shen (元参, Scrophularia), 8 qian of Mai Dong (麦冬, Ophiopogon), and 8 qian of Sheng Di (生地, 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 the patient has not had a bowel movement for several days, one should use purgative methods. If the patient has a deficiency of Yin fluids, even if there is constipation, Chengqi Decoction should not be used; instead, Zeng Ye Tang should be administered. 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 purgative effect to harmonize the stomach qi and facilitate bowel movements. The above discusses the conditions in Yangming warm disease where purgative methods can be applied, establishing three treatment methods: for heat accumulation in the intestines and significant Yin fluid depletion, Da Cheng Qi Tang (大承气汤, Major Purgative Decoction) should be used; for cases leaning towards heat accumulation in the intestines with less obvious Yin fluid damage, Tiao Wei Cheng Qi Tang should be used; and for cases leaning towards 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 and deficiency of body fluids leading to constipation, characterized by hard stools, thirst, a dry red tongue, and a thin, rapid or weak pulse. This condition is caused by pathogenic heat depleting body fluids, leading to Yin deficiency and dryness, which cannot moisten the intestines. Therefore, it heavily utilizes Xuan Shen (玄参, Scrophularia) for its salty, cold, and Yin-nourishing properties to clear heat and moisten dryness, Sheng Di (生地, Rehmannia) for its sweet, cold, heat-clearing, and Yin-nourishing properties, and Mai Dong (麦冬, Ophiopogon) for its sweet, cold, and nourishing properties for the lungs and stomach. These three herbs are salty, sweet, bitter, and cold, nourishing Yin, increasing fluids, and clearing heat, hence the term “salty, cold, bitter, sweet method.” Adjustments: If the dryness and heat of body fluid deficiency are severe and Zeng Ye Tang does not lead to a bowel movement, Sheng Da Huang (生大黄, Rhubarb) and Mang Xiao (芒硝, Glauber’s salt) can be added to clear heat and promote bowel movements, 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, with dry mouth, scanty menstruation, normal urination, and normal appetite. Her tongue was red with a thin coating, and her pulse was thin and slightly rapid. After consulting a teacher of warm disease, she was prescribed: Sheng Di Huang (生地黄, Rehmannia) 30g, Xuan Shen (玄参, Scrophularia) 50g, Mai Dong (麦冬, Ophiopogon) 30g, Sha Ren (砂仁, Amomum) 3g, Rou Cong Rong (肉苁蓉, Cistanche) 18g, Gua Lou (瓜蒌, Trichosanthes) 60g, Ma Zi Ren (麻子仁, Cannabis Seed) 25g, for 7 doses. After no effect, 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 (当归, Angelica) 12g, Rou Cong Rong 20g, Bai Zhu (白术, Atractylodes) 30g, Hei Zhi Ma (黑芝麻, Black Sesame) 30g, Zhi Wan (炙紫菀, Aster) 20g, Yu Li Ren (郁李仁, Prunus) 15g, Sheng Mai Ya (生麦芽, Barley) 20g, for 7 doses. Bowel movements returned to once daily, tongue was slightly red, 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 Wan 12g, Yu Li Ren 15g, Chao Zhi Ke (炒枳壳, Stir-fried Bitter Orange) 10g, Sheng Mai Ya 20g, Lai Fu Zi (莱菔子, Radish Seed) 10g, Xing Ren (杏仁, Apricot Kernel) 10g. 2. Case of Yang Jin: Treated a patient with habitual constipation for over 10 years, age 55, with symptoms of dry mouth, excessive thirst, weight loss, five hearts heat, red tongue with little coating, and bowel movements once every week or longer, requiring the use of laxatives to facilitate bowel movements. Initially, due to typical signs of Yin deficiency, Wu Ren Wan (五仁丸, Five Nut Pill) and Ma Zi Ren Wan (麻子仁丸, Cannabis Seed Pill) were used, but with poor results. Later switched to Zeng Ye Tang, but the effect was still not significant, and it was necessary to add Da Huang (大黄, Rhubarb). Considering that the patient rarely felt the urge to defecate and had to strain significantly, it was determined to be a sign of intestinal qi deficiency. Additionally, considering the patient’s age, kidney qi was also deficient, so Huang Qi (黄芪, Astragalus) 18g and Rou Cong Rong 15g were added to the formula, which resulted in good effects without needing to add Da Huang for bowel movements. After continuous treatment for over a month, the constipation was basically cured.

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