小承气汤

4. Granule conversion and dose

Calculation of total raw herb weight in the original formula:

Da Huang (rhubarb rhizome) 12 g + Hou Po (magnolia bark) 6 g + Zhi Shi (immature bitter orange) 9 g = 27 g.

Converted to 5:1 granules:

27 g raw herbs ÷ 5 = 5.4 g granules.

Dose of granules: Dissolve in warm water and take twice daily, morning and evening, about 3 g per dose. (This formula is a precipitating formula; once bowel movement is achieved (stools flow freely), discontinue the remainder.)

5. Cautions and clinical notes

• Contraindications:
  1. This is an aggressive purgative formula and is therefore absolutely contraindicated in pregnancy.
  2. It should not be used in patients with unresolved exterior patterns, interior cold from deficiency, or yin deficiency with fluid depletion.
  3. Use with caution in the elderly and the physically weak.
• Key point: The essential diagnostic features for this formula are fullness, distension and excess (epigastric and abdominal fullness and distension with constipation), while signs of dryness are not prominent (it lacks the abdominal pain with resistance to pressure, hard bound dry stool, and scorched-black tongue coating seen with Da Cheng Qi Tang).
• Modern applications: Mainly used for acute simple intestinal obstruction, acute cholecystitis, acute pancreatitis, habitual constipation, and viral hepatitis, in cases presenting the mild Yangming bowel excess pattern.
• Duration of use: This formula rapidly precipitates heat to preserve yin; discontinue once the condition resolves. Do not exceed the appropriate dose or duration, to avoid damaging stomach qi.