Tong Xie Yao Fang: A Chinese herbal medicine for Painful Diarrhea

Chinese herbal medicine, Tong Xie Yao Fang, or the "Important Formula for Painful Diarrhea," is a renowned herbal prescription from Danxi Xinfa, a medical text by Ming Dynasty physician Zhu Danxi. This formula targets painful diarrhea caused by a weak spleen and an overactive liver, a condition known as liver-spleen disharmony in traditional Chinese medicine (TCM).

With just four herbs, it effectively relieves abdominal pain and diarrhea while restoring balance to the body. This article explains the formula’s ingredients, how it works, its modern applications, and key precautions.

Tong Xie Yao Fang: A Chinese herbal medicine for Painful Diarrhea

Chinese herbal medicine Ingredients and Their Roles

Tong Xie Yao Fang uses a simple yet powerful blend of four herbs:

• Atractylodes Macrocephala (Main Herb): This herb boosts qi, strengthens the spleen, and removes dampness, addressing diarrhea caused by spleen weakness.

• White Peony Root (Minister Herb): Cool in nature, it soothes liver qi to relieve sharp abdominal pain, complementing atractylodes for liver-spleen balance.

• Chenpi (Adjuvant Herb): Bitter and mild, dried tangerine peel regulates qi, dries dampness, and aids digestion, tackling qi stagnation and bloating.

• Fangfeng (Guiding Herb): Pungent and uplifting, fangfeng disperses liver stagnation, supports the spleen, and helps stop diarrhea.

Together, these herbs strengthen the spleen, calm the liver, remove dampness, and halt diarrhea.

How Chinese herbal medicine Tong Xie Yao Fang Works

In TCM, the spleen governs digestion, while the liver regulates qi and emotions. When the spleen is weak and the liver is overactive, the liver overpowers the spleen, disrupting digestion and causing abdominal pain and diarrhea.

This imbalance, described as "earth deficiency and wood overpowering," leads to symptoms like frequent, watery stools, abdominal pain that eases after bowel movements but recurs, bloating, irritability, and emotional stress.

Tong Xie Yao Fang addresses this liver-spleen disharmony by:

• Strengthening the spleen with atractylodes to improve digestion and stop diarrhea.

• Soothing the liver with white peony to reduce pain and tension.

• Regulating qi and drying dampness with chenpi to ease bloating.

• Balancing the liver and spleen with fangfeng to stop diarrhea and calm the system.

Tong Xie Yao Fang: A Chinese herbal medicine for Painful Diarrhea

Key symptoms this formula treats include:

• Abdominal pain and cramping.

• Frequent, watery diarrhea.

• Pain relief after bowel movements.

• Thin, white tongue coating.

• Pulse that feels wiry on the left and slow on the right..

Liver excess and spleen deficiency

Therapeutic Effects

Tong Xie Yao Fang’s primary goal is to "tonify the spleen, soften the liver, remove dampness, and stop diarrhea." It restores spleen function to improve digestion and calms liver qi to relieve pain. The formula’s balanced approach ensures both the root cause (liver-spleen disharmony) and symptoms (pain and diarrhea) are addressed.

By harmonizing these organs, it also stabilizes emotions, reducing irritability and stress that worsen the condition.

Harmonize the liver and spleen

Modern Applications of Chinese herbal medicine Tong Xie Yao Fang

In modern medicine, Tong Xie Yao Fang is widely used for conditions involving spleen deficiency and liver hyperactivity, such as:

• Irritable Bowel Syndrome (IBS): Relieves abdominal pain, diarrhea, and bloating.

• Acute and Chronic Enteritis: Reduces inflammation and improves digestion.

• Chronic Colitis: Eases chronic digestive symptoms.

Tong Xie Yao Fang /痛瀉要方, 5:1 Concentrated Granules

Buy Now

Pharmacological studies support its effectiveness, particularly for IBS. For example, a study by Han treating 96 IBS patients with a modified version of the formula achieved a 90.62% success rate. The formula is often combined with other TCM remedies, like Si Shen Wan or Fu Zi Li Zhong Tang, to enhance its effects for severe cases or cold-related diarrhea.

Precautions

To ensure safe and effective use, keep these points in mind:

• Accurate Diagnosis: This formula is not for diarrhea caused by food poisoning, which requires different treatment.

• Contraindications: Avoid using it for diarrhea with heat-related symptoms (e.g., burning sensations or fever), as the formula’s warm and drying herbs may worsen these conditions.

• Medical Guidance: Confirm the patient’s symptoms align with spleen deficiency and liver hyperactivity before use.

Chinese Name	痛瀉要方
Phonetic	Tong Xie Yao Fang
English Name	Important Formula for Painful Diarrhea
Classification	Harmonizing formulas
Source	《Teachings of [Zhu] Dan-xi》Dan Xi Xin Fa《丹溪心法》
Combination	Atractylodis Macrocephalae Rhizoma (Bai Zhu dry-fried) 3 liang (90g), Paeoniae Radix Alba (Bai Shao dry-fried) 2 liang (60g), Citri Reticulatae Pericarpium (Chen Pi dry-fried) 1.5 liang (45g), Saposhnikoviae Radix (Fang Feng) 1 liang (30g)
Method	Prepare as a decoction.
Action	Supplements the spleen and softens the liver, dispels dampness and arrests diarrhea.
Indication	Painful diarrhea due to a deficient spleen and a vigorous liver, characterized by borborygmus, abdominal pain, diarrhea with abdominal pain, pain that is relieved after diarrhea, the guan pulses of both hands not in harmony (a wiry pulse on the left hand and a moderate pulse on the right).
Pathogenesis	Painful diarrhea is due to wood over-restricting the earth, liver-spleen disharmony, and the spleen failing to transport. As mentioned in《Investigations of Medical Formulas》, “diarrhea is caused by the spleen deficiency while the pain is due to liver excess. A deficient spleen and a vigorous liver may result painful diarrhea.” The methods of supplementing the spleen and inhibiting the liver, dispelling dampness, and arresting diarrhea are appropriate to use because there is diarrhea and abdominal pain.
Application	1. Essential pattern differentiation Tong Xie Yao Fang is a commonly used formula for painful diarrhea due to liver-spleen disharmony. This clinical pattern is marked byborborygmus, abdominal pain, diarrhea with abdominal pain, pain relieved after diarrhea, wiry pulse on the left guan, a moderate pulse on the right guan, and disharmony between both guan. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of a deficient spleen and a vigorous liver: acute enteritis, chronic colitis, and irritable bowel syndrome.