Abdominal findings and heat patterns help distinguish it from Chengqi-Tang formulas
By Jubong Kang KMD
*Ingredients: Houpo (厚朴: bitter, pungent, warm) 12g; Dahuang (大黃: bitter, cold) 6g; Zhishi (枳實: bitter, pungent, slightly cold) 6g.
Houpo-Sanwu-Tang is used for constipation with abdominal pain and distention caused by intestinal stagnation. It is especially appropriate when food remains stagnant in the intestines without a clear heat pattern or fully formed dry stool.
Acts and Diagnosis
Its ingredients are similar to those of Xiao-Chengqi-Tang, while Mangxiao is omitted. When heat and dry stool are clearly present, Xiao-Chengqi-Tang or Da-Chengqi-Tang is more appropriate. When heat is absent and intestinal contents are stagnant but dry stool has not yet formed, Houpo-Sanwu-Tang is preferred.
Compared with Xiao-Chengqi-Tang, this formula contains less Zhishi and more Houpo. Houpo serves as the chief herb, promoting qi movement, reducing accumulation, and drying dampness. It helps relieve food stagnation, phlegm retention, gas, abdominal distention, pain, and constipation.
Dahuang acts as the minister herb, purging intestinal accumulation, clearing heat, and promoting the resolution of blood stasis. Xiao-Chengqi-Tang contains relatively more Dahuang and Zhishi and is therefore a stronger purgative, while the higher proportion of Houpo makes Houpo-Sanwu-Tang gentler. Adding Mangxiao further strengthens the purgative action.
Zhishi serves as an adjuvant herb, breaking qi stagnation, reducing accumulation, resolving phlegm, and relieving focal distention. Together with Houpo and Dahuang, it helps relieve abdominal fullness, pain, and constipation.
In Yao Zheng, Yoshimasu Todo described Houpo as treating chest and abdominal distention, Zhishi as treating focal accumulation and fullness, and Dahuang as treating abdominal distention, pain, and constipation, with additional effects on blood stasis and swelling.
Typical findings include a deep, forceful pulse, yellowish tongue coating, abdominal distention, constipation, and marked epigastric or lower abdominal tenderness. When severe atopic or purulent dermatitis is accompanied by pronounced lower abdominal distention and tenderness, Houpo-Sanwu-Tang may be combined with an appropriate dermatologic formula.
Application
Abdominal fullness and epigastric pain with constipation, or epigastric fullness and pain with vomiting of water (Fang Ji).
Severe abdominal pain and tenesmus due to dysentery. Atopic dermatitis, purulent dermatitis, headache, and related symptoms accompanied by bloating and severe lower abdominal tenderness.
Distinction
- Xiao-Chengqi-Tang: It presents a stronger excess and heat pattern than Houpo-Sanwu-Tang. Typical findings include hard stool, abdominal fullness and pain, constipation, a forceful pulse, and yellow tongue coating.
- Da-Chengqi-Tang: It presents a stronger excess and heat pattern than Xiao-Chengqi-Tang. Typical findings include a firm abdomen, abdominal tenderness, a deep, forceful pulse, a dry tongue, and thick yellow or black coating.
- Tiaowei-Chengqi-Tang: Typical findings include thirst, constipation or diarrhea, abdominal pain and tenderness with resistance to palpation, restlessness, a pulse that is not weak, and yellow tongue coating. Because the formula does not contain Houpo or Zhishi, abdominal fullness is generally absent. However, resistance and tenderness around the navel may serve as characteristic abdominal findings.
