IIntroduction: Zengye Decoction (增液汤) has the effect of increasing fluids and moistening dryness, primarily treating Yangming warm disease and fluid deficiency leading to constipation, characterized by hard stools, thirst, and a dry red tongue. Patients with fluid deficiency and constipation can choose this formula for treatment.
Zengye Decoction
Author: Li Caiyun
[Original Text] In Yangming warm disease, without upper jiao symptoms, if there is no 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 (承气汤) but rather Zengye Decoction. After taking Zengye Decoction, observe for 24 hours; if there is still no bowel movement, combine it with a mild adjustment using Chao Wei Chengqi Decoction (调胃承气汤). The formula for Zengye Decoction (salty, cold, bitter, sweet method): 1 liang of Yuan Shen (元参), 8 qian of Mai Dong (麦冬, Ophiopogon), and 8 qian of Sheng Di Huang (生地黄, 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, one should use purgative methods for treatment. If the patient has a deficiency of Yin fluids, even if there is constipation, Chengqi Decoction should not be used; instead, Zengye Decoction should be administered. After taking Zengye Decoction, observe for 24 hours; if there is still no bowel movement, it can be combined with Chao Wei Chengqi Decoction for a gentle purgative effect to harmonize the stomach qi and facilitate bowel movements. The above discusses the purgative methods applicable to Yangming warm disease, establishing three treatment methods: for heat accumulation in the intestines and significant Yin fluid depletion, Da Chengqi Decoction (大承气汤) should be used; for cases with a focus on heat accumulation in the intestines but less obvious Yin fluid damage, Chao Wei Chengqi Decoction should be used; for cases with a focus on Yin fluid depletion and less heat accumulation, Zengye Decoction should be used. This emphasizes the importance of protecting Yin fluids in patients with warm disease when Yin fluids are already deficient.[Clinical Application] Zengye Decoction has the effect of increasing fluids and moistening dryness, primarily treating Yangming warm disease and fluid deficiency leading to constipation, characterized by hard stools, thirst, a dry red tongue, and a fine rapid or weak pulse. This condition is due to pathogenic heat consuming fluids, leading to Yin deficiency and dryness, which cannot moisten the intestines. Therefore, it heavily uses Xuan Shen (玄参, Scrophularia) for its salty, cold, Yin-nourishing, and dryness-moistening properties, Sheng Di Huang for its sweet, cold, heat-clearing, and Yin-nourishing properties, and Mai Dong for its sweet, cold, lung and stomach-nourishing properties. These three herbs, being salty, cold, bitter, and sweet, nourish Yin, increase fluids, and clear heat, hence the “salty, cold, bitter, sweet method.” Adjustments: If fluid deficiency and dryness-heat are severe, and after taking Zengye Decoction there is still no bowel movement, one can add Sheng Da Huang (生大黄, Rhubarb) and Mang Xiao (芒硝, Glauber’s salt) 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 dry and hard stools, having a bowel movement every 4-5 days, with hard texture, thirst, scant menstruation, normal urination, and normal appetite. Her tongue was red with thin coating, and her pulse was fine and slightly rapid. After consulting a warm disease specialist, she was 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 persistent constipation. Professor Meng Jingchun prescribed: Xuan Shen 15g, Sheng Di Huang 12g, Mai Dong 10g, Dang Gui 12g, Rou Cong Rong 20g, Sheng Bai Zhu 30g, Hei Zhi Ma 30g, Zhi Zi 20g, Yu Li Ren 15g, Sheng Mai Ya 20g, for 7 doses. Bowel movements occurred once a day, with a slightly pale red tongue, 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, Sheng Bai Zhu 40g, Hei Zhi Ma 30g, Zhi Zi 12g, Yu Li Ren 15g, Chao Zhi Ke 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 thirst, weight loss, five hearts heat, red tongue with little coating, and bowel movements once a week or longer, requiring laxatives to assist. Initially, due to typical Yin deficiency symptoms, treated with Wu Ren Wan (五仁丸) and Ma Zi Ren Wan (麻子仁丸) with poor results. Later switched to Zengye Decoction, which also showed little effect unless Da Huang was added. Considering the patient’s infrequent urge to defecate and difficulty during bowel movements, it was determined to be a sign of intestinal qi deficiency. Given the patient’s age, kidney qi was also considered deficient, so 18g of Huang Qi (黄芪, Astragalus) and 15g of Rou Cong Rong were added to the formula, resulting in significant improvement without the need for Da Huang, achieving regular bowel movements. Continuous treatment for over a month led to basic resolution of constipation.This article is excerpted from “Essentials of Warm Disease Differentiation and Clinical Practice,” published by Shanxi Science and Technology Press. Author: Li Caiyun. Please cite the source when reproducing.
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