Da Cheng Qi Tang: A Classic TCM Formula for Constipation and Heat Relief

Da Cheng Qi Tang, a powerful Traditional Chinese Medicine (TCM) formula, hails from Zhang Zhongjing’s Treatise on Febrile Diseases, a cornerstone of Chinese medicine from the Eastern Han Dynasty.

Created during a time of war and widespread illness, this remedy reflects Zhang’s genius in treating severe digestive issues. Like a trusted healer, Da Cheng Qi Tang steps in to relieve constipation, clear internal heat, and restore balance, making it a timeless solution for gut health.

Da Cheng Qi Tang

Origins and Ingredients of Da Cheng Qi Tang

Da Cheng Qi Tang combines four potent ingredients, each with a unique role:

• Rhubarb: A strong laxative, rhubarb acts like a bold leader, clearing heat, breaking up stagnation, and promoting bowel movements.

• Magnolia Bark: Warm and steady, magnolia bark eases bloating, promotes energy flow, and reduces dampness in the gut.

• Bitter Orange (Zhi Shi): Sharp and effective, bitter orange tackles abdominal fullness, clears phlegm, and boosts digestion.

• Sodium Sulfate (Mang Xiao): Salty and cooling, sodium sulfate softens hard stools, moistens the intestines, and enhances bowel movements.

Together, these herbs deliver a forceful yet balanced effect, clearing blockages and cooling the body with remarkable precision.

Main Benefits

Da Cheng Qi Tang excels at relieving severe constipation and clearing internal heat, particularly for conditions like “Yangming Fu Shi Syndrome,” where heat and waste accumulate in the gut. Its key effects include:

• Powerful Laxative Action: It clears hard, dry stools and restores normal bowel function.

• Heat Clearance: It cools the body, reducing fever and inflammation caused by trapped heat.

• Relief of Abdominal Discomfort: It eases bloating, pain, and fullness in the abdomen.

Symptoms of Yangming Fu Shi Syndrome

Symptoms of Yangming Fu Shi Syndrome

This condition involves:

• Stuffiness (Pi): A heavy, pressured feeling in the chest or abdomen.

• Fullness (Man): A bloated abdomen that feels resistant when pressed.

• Dryness (Zao): Hard, dry stools that are difficult to pass.

• Hardness (Shi): Intense abdominal pain or hard lumps, sometimes with watery diarrhea that doesn’t relieve discomfort.

Other signs include fever, confusion, cold sweats, a dry or cracked yellow tongue coating, and a strong pulse. While all symptoms don’t need to be present, constipation, bloating, pain, and a thick yellow tongue coating guide its use.

Da Cheng Qi Tang /大承氣湯, 5:1 Concentrated Granules

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How It Works

In TCM, the Yangming meridian governs the stomach and intestines. When heat or external pathogens invade, they can combine with undigested food, causing constipation and inflammation.

Da Cheng Qi Tang clears this heat, breaks up blockages, and restores smooth digestion and elimination. Here’s how each herb contributes:

• Rhubarb: Purges heat, clears stagnation, and promotes bowel movements.

• Sodium Sulfate: Softens stools and enhances rhubarb’s heat-clearing power.

• Magnolia Bark: Relieves bloating by moving stagnant energy.

• Bitter Orange: Breaks up blockages and supports digestion.

Together, they create a dynamic formula that clears heat, moves energy, and relieves discomfort.

Da Cheng Qi Tang /大承氣湯, 5:1 Concentrated Granules

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Clinical Uses

Da Cheng Qi Tang is used for serious digestive and inflammatory conditions, including:

• Acute intestinal obstructions (simple, adhesive, or parasitic).

• Acute cholecystitis, pancreatitis, appendicitis, or pyloric obstruction.

• Severe abdominal emergencies.

• Febrile diseases like tonsillitis, coma, convulsions, or madness.

• Infections like epidemic encephalitis B or septic shock.

Its versatility makes it a key tool in TCM for acute and chronic gut issues.

Dietary Support

Pairing Da Cheng Qi Tang with simple recipes can support digestion and recovery:

1. Barley Porridge

   • Ingredients: 50g barley (coix seed), 100g rice.

   • Method: Cook barley and rice in water until soft, serve warm.

   • Benefits: Clears dampness and supports spleen health.

2. Yam Soup

   • Ingredients: 1 yam, sliced.

   • Method: Boil yam in water until tender, season lightly.

   • Benefits: Nourishes the spleen and stomach, aiding digestion.

3. Radish Soup

   • Ingredients: 1 radish, sliced.

   • Method: Boil radish in water until soft, season lightly.

   • Benefits: Breaks up stagnation and promotes bowel movements.

4. Mung Bean Soup

   • Ingredients: 50g mung beans.

   • Method: Boil mung beans in water until soft, sweeten lightly if desired.

   • Benefits: Clears heat and supports detoxification.

Massage Support

Massage can enhance Da Cheng Qi Tang’s effects by stimulating digestion:

• Tianshu Point: Two inches on either side of the navel. Massage gently for 5-10 minutes to ease bloating and constipation.

• Zhongwan Point: Four inches above the navel. Massage for 5-10 minutes to support spleen and stomach function.

• Zusanli Point: Three inches below the knee. Massage for 5-10 minutes to boost gut movement.

• Hegu Point: At the base of the thumb on the hand’s back. Massage for 5-10 minutes to improve energy flow.

Precautions

Da Cheng Qi Tang is potent and not suitable for everyone:

• Pregnant Women: Avoid it, as its strong laxative effect may harm the fetus.

• Weak Constitution: Use cautiously, as it could further deplete energy.

• Medical Supervision: Always follow a TCM practitioner’s guidance to ensure safe use.

Conclusion

Da Cheng Qi Tang is a TCM masterpiece, blending rhubarb, magnolia bark, bitter orange, and sodium sulfate to tackle severe constipation and internal heat. From intestinal blockages to acute infections, it restores balance with precision.

Support its effects with barley porridge, radish soup, or gentle massage, but always consult a TCM expert for safe use. This ancient formula remains a powerful ally for gut health and overall wellness.

Chinese Name	大承氣湯
Phonetic	Da Cheng Qi Tang
English Name	Major Purgative Decoction
Classification	Purgative formulas
Source	《Treatise on Cold Damage》Shang Han Lun《傷寒論》
Combination	Rhei Radix et Rhizoma (Da Huang) 4 liang (12g), Magnoliae Officinalis Cortex (Hou Po) 0.5 jin (24g), Aurantii Fructus Immaturus (Zhi Shi) 5 pieces (12g), Natrii Sulfas (Mang Xiao) 3 he (9g)
Method	Da Cheng Qi Tang is prepared as a decoction. Hou po and zhi shi should be decocted first, then da huang added later while it is cooking, and finally dissolve the mang xiao into the strained decoction. The decoction should be taken warm in two divided doses for oral administration. Once loose stool appears, the decoction should be discontinued.
Action	Drastically purges heat accumulation.
Indication	1. Excess heat in the yangming fu-organs. The symptoms are constipation with frequent flatulence, gastric stuffiness and abdominal fullness, abdominal pain that feels worse with pressure, and the abdomen is tense and firm when pressed. In severe cases, there may be tidal fever, delirious speech, and profuse sweating from the palms and soles. The tongue coating is dry and yellow with prickles, or dry and parched black with cracks. The pulse is deep and excessive. 2. Heat retention with watery discharge. The symptoms are watery green, foul-smelling diarrhea, umbilical and abdominal pain, hardness with clumps felt when pressing the abdomen, and a dry mouth and tongue. The pulse is slippery and excessive. 3. Internal excess heat. The symptoms are heat inversion (heat syncope), convulsive disease, and mania.
Pathogenesis	The pathogenesis of this pattern is exuberant yangming heat that consumes fluids and dries the stool. Pathogenic heat binds with dry stool to form an excess pattern, which obstructs the qi of the fu-organ. Therefore, the characteristics of this pathomechanism may be simplified as “stuffiness, fullness, dryness, and excess”. Stuffiness refers to the sensation of oppression, obstruction, and heaviness focused in the chest and epigastrium. Fullness refers to distention and fullness of the epigastrium and abdomen that is resistant to palpation. Dryness refers to dry bound stool that accumulates in the intestines causing difficult defecation. Excess refers to the accumulation of heat that has taken form, abdominal pain that is resistant to pressure, constipation, tidal fever, delirious speech, and an excess pulse. When there is watery diarrhea, neither the abdominal fullness nor pain is relieved. When qi stagnation constrains the distribution of yang qi throughout the four limbs, it leads to a pattern called heat inversion. Exuberant heat damages and dries the fluids which causes spasms of tendons and vessels because of the loss of nourishment, which is referred to as convulsive disease. Pathogenic yangming heat rises to disturb the spirit of heart, located above the yangming domain, causing mania. Although all of these manifestations are different, they have the same pathomechanism of severe heat accumulation. It should be treated by drastically purging the heat accumulation in order to prevent the depletion of fluids. This treatment method is described as extracting the firewood from under the cauldron.
Clarification	1. Da Cheng Qi Tang treats heat retention with watery discharge. If there is watery discharge, why is the purgative method still used? An indication of this formula, watery discharge, is caused by dry, hard stool, which fails to be expelled by the stomach and intestines and is retained in the interior. Thereby intestinal fluid moves down the intestinal tract and forced around the dry stool in the intestines. Even after the patient excretes turbid foul-smelling watery discharge, they will still have hard knots in the abdomen that render it painful around the umbilicus. Actually the watery discharge is an indirect “false” sign whereas the hard and dry stool is the real cause. Therefore, Da Cheng Qi Tang is used to “treat the flowing by promoting its flow” by expelling dry stool in the stomach and intestines through purgation so the diarrhea can be stopped. 2. What is the mechanism of this formula that treats heat syncope? The reversal counter-flow cold of the limbs is a false symptom while internal excess of heat bind is the true pathology; akin to the concept “the more severe the heat is, the more severe the syncope is”. Though the patient has cold limbs, he must also have signs of internal excess and heat bind, such as constipation, abdominal pain aggravated by pressure, dry mouth with thirst, and a slippery, excess pulse. This formula clears heat bind through drastic purgation, which then allows the qi movement to normalize and the limbs to warm by the arrival of yang qi. This method is also called “treating cold with cold” because it treats cold limbs with cold purgation. 3. Why is it that this formula does not have to be combined with medicinals that cool the liver, extinguish wind, nourish yin, and relax the tendons in order to treat convulsions? The convulsion treated by this formula is caused by exuberant heat in the stomach and intestines drying up the body fluids. The tendons then convulse because of the lack of nourishment. The patient must have signs of excess heat, such as constipation, dry mouth, and a slippery, rapid pulse. This formula saves yin through drastic purgation, so the fluids can be recovered in order to nourish the tendons. Once the heat is gone, the convulsion is stopped. This is the method of treating the root. 4. Why should da huáng be raw and added into the decoction towards the end of the cook regime? Da Cheng Qi Tang was formulated to drastically purge. The purgative power of raw da huang is stronger especially when it is cooked for a short time. Prepared da huang has a gentler purgative action, more so when decocted longer.
Application	1. Essential pattern differentiation Da Cheng Qi Tang is the basic formula used to treat yangming bowel excess and the representative formula of cold purgation. This clinical pattern is marked by pi, fullness dryness, excess, red tongue with a yellow coating and deep excess pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of a yangming bowel excess pattern: acute simple intestinal obstruction, adhesive intestinal obstruction, ascaris intestinal obstruction, acute cholecystitis, acute pancreatitis, and incomplete pyloric obstruction; or when the patient shows signs of constipation, a yellow tongue coating, and an excess pulse: hyperpyrexia, unconsciousness, delirious speech, fright syncope, or mania in the course of febrile disease. 3. Cautions and contraindications It is not applicable for patients diagnosed with qi and yin deficiency, slight dryness and stagnation, or for those who are aged and weak. It is forbidden to use for pregnant women. Avoid taking a high dose in order to prevent the zheng qi from being damaged.
Additonal formulae	1. Xiao Cheng Qi Tang (Minor Purgative Decoction, 小承氣湯) [Source]《Treatise on Cold Damage》Shang Han Lan《傷寒論》 [Ingredients] Da huang 4 liang (12g), hou po 2 liang (6g), zhi shi three big pieces (9g) [Preparation and Administration] Prepare it as a decoction. The decoction should be taken in two divided doses for warmly oral administration. Once the loose stool appeared, the use of decoction should be discontinued. [Actions] Expels heat bind by mild purgation. [Applicable Patterns] Mild cases of yangming bowel excess. Symptoms include: hard stool, abdominal pi and distention, delirious speech, tidal fever, a tough yellow tongue coating, a slippery, rapid pulse, dysentery initially due to heat accumulating in the stomach and intestine, and abdominal urgency with rectal heaviness. 2. Tiao Wei Cheng Qi Tang (Stomach-Regulating and Purgative Decoction, 調胃承氣湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Da huang 4 liang (12g), zhi gan cao 2 liang (6g), mang xiao 0.5 sheng (9g) [Preparation and Administration] Prepare it as a decoction. Da huang and gan cao should be decocted first, dissolve mang xiao in the strained decoction. [Actions] Expels heat bind with mild purgation. [Applicable Patterns] Interior bind of heat and dryness pattern of yangming bowel excess. Symptoms include: constipation, thirst, vexation, steaming fever delirious speech, a yellow tongue coating, a slippery, rapid pulse, macules, hematemesis, epistaxis, swollen and painful mouth, gums, and throat caused by exuberant heat in the stomach and intestines. 3. Fu Fang Da Cheng Qi Tang (Compound Formula Major Purgative Decoction, 復方大承氣湯) [Source]《Treating Acute Abdominal Disease by Integrative Treatment》Zhong Xi Yi Jie He Zhi Liao Ji Fu Zheng《中西醫結合治療急腹症》 [Ingredients] Hou po 15-20g, lai fu zi 15-30g, zhi qiao 15g, tao ren 9g, chi shao 15g, da huang 9-15g (added later), mang xiao 9-15g [Preparation and Administration] Prepare it as a decoction. [Actions] Unblocks the interior by purgation, moves qi and invigorates blood. [Applicable Patterns] This formula may be used in the following biomedically defined disorder such as simple intestinal obstruction when the patient shows signs of yangming bowel excess pattern complicated by obvious abdominal pain and distention.

大承氣湯