大承气汤

3. Tongue and pulse

• Tongue: Red tongue with a thick, dry yellow coating, or a scorched black coating with prickles.
• Pulse: Deep, forceful pulse, or slippery and rapid pulse.

4. Common modifications

• This formula is a heavy purgative and is generally not modified extensively, so as to keep its action focused.
• For accompanying fluid depletion with dry mouth and thirst: add Xuan Shen (scrophularia root), Sheng Di (fresh rehmannia root), and Mai Men Dong (ophiopogon tuber) (forming Zeng Ye Cheng Qi Tang, Increase the Fluids and Order the Qi Decoction) to nourish yin, increase fluids, purge heat, and promote bowel movement.
• For exuberant lung heat with dyspnea and restlessness: may be combined with the approach of Xuan Bai Cheng Qi Tang, adding Shi Gao (gypsum), Xing Ren (apricot kernel), and Gua Lou Pi (trichosanthes peel).

5. Cautions and clinical notes

• Absolute contraindications:
  • Not to be used when exterior pattern is unresolved and interior excess has not yet formed.
  • Contraindicated in the elderly, the weak, pregnant women, postpartum women, and those with long-term illness with fluid depletion or yin deficiency.
  • Contraindicated in intestinal obstruction with impaired blood circulation (strangulation) or suspected intestinal necrosis; surgical treatment is required in these cases.
• This formula is a drastic purgative; discontinue once the condition resolves, and do not exceed the appropriate dose, so as to avoid damaging the body's righteous qi.
• After taking this formula, if the bowels have moved and the abdominal pain and distension have lessened, stop the medication immediately.

6. Granule conversion and dose

• Calculation of the total raw herb weight of the original formula:
  • Da Huang (rhubarb root and rhizome) 12g + Mang Xiao (mirabilite) 9g + Zhi Shi (immature bitter orange) 12g + Hou Po (magnolia bark) 24g = 57 g.
• Conversion to 5:1 granules:
  • 57 g raw herb ÷ 5 = 11.4 g granules.
• Recommended dose:
  • This is the amount for a single dose taken at once, or divided into two doses dissolved in water.
  • Extremely important notice: Da Cheng Qi Tang (Major Rhubarb Combination) is a formula used for emergency, critical conditions and must be used under the close supervision of a physician. Patients must not calculate the dose or take this formula on their own! The physician will determine the number of doses and the dosage based on the severity of the condition; in some cases only a single dose is needed, and the medication is stopped once the bowels move.