枳实导滞散

4. Granule conversion and dose

Calculation of the total raw herb weight of the original formula:

Zhi Shi (immature bitter orange) 15 g + Da Huang (rhubarb rhizome) 30 g + Huang Qin (baikal skullcap root) 9 g + Huang Lian (coptis rhizome) 9 g + Fu Ling (poria) 9 g + Bai Zhu (white atractylodes rhizome) 9 g + Ze Xie (alisma rhizome) 6 g + Shen Qu (medicated leaven) 15 g = 102 g.

Converted to 5:1 granules:

102 g raw herbs ÷ 5 = 20.4 g granules.

Granule dose: Dissolve in warm water and take in 2 doses, morning and evening, about 10 g per dose. (The original formula was a pill; the granule form is absorbed more quickly and should be taken after meals to reduce irritation to the stomach and intestines.)

5. Cautions and clinical notes

Contraindications:

1. Absolutely contraindicated in pregnancy, because Da Huang, Zhi Shi and other herbs in the formula have blood-moving, purgative, and strongly qi-moving/qi-breaking effects.
2. Contraindicated in Spleen-Stomach deficiency cold without damp-heat accumulation.
3. Should not be used indiscriminately in diarrhea/dysentery without accumulation, or in patients with long-standing illness and underlying deficiency.

Safety warnings:

1. Da Huang in the formula has a relatively strong purgative action; some patients may experience diarrhea after taking it. This is a normal pharmacological effect intended to unblock the bowels and purge accumulation. If purgation is excessive, the dose should be reduced or discontinued as appropriate.
2. This formula is an attacking and purging preparation with fairly strong action. It should be stopped once the disease resolves, and should not be overdosed or taken long-term, to avoid damaging the Spleen and Stomach's healthy qi.

Modern applications: Mainly used for indigestion, acute gastroenteritis, bacillary dysentery, chronic constipation, cholecystitis, and pyloric obstruction, where the pattern is damp-heat food stagnation obstructing internally in the intestines and stomach.

Duration of use: This formula is for acute, excess conditions. It is usually taken for 1-3 days; once the accumulation has been resolved and symptoms have eased, it should be discontinued, or switched to a formula for regulating the Spleen and Stomach. It is not recommended for long-term use as a laxative.