Diyu Yin (Garden Burnet Drink) for Intestinal Abscess
In Chen Jie's Huisheng Ji (Collection of Life-Reviving Prescriptions) of the Qing dynasty there is a formula called "Diyu Yin" (Garden Burnet Drink) for treating intestinal abscess of the large and small intestine. The formula consists of 500 g of garden burnet root (Diyu), 60 g of licorice root (Gancao), and 30 g of honeysuckle flower (Jinyinhua). When using it, first decoct the Diyu in 2.5 liters of water down to 750 ml, then add the Gancao and Jinyinhua and decoct further down to 250 ml. Remove the dregs and take warm on an empty stomach, twice daily. The above measurements are all converted to modern dosages.
This formula has the actions of clearing heat and resolving toxin, and cooling blood and dispelling abscess. It is indicated for intestinal abscess of the large and small intestine. During medication, fishy foods must be avoided and sexual intercourse must be abstained from. Intestinal abscess of the large and small intestine belongs to acute abdominal conditions and is generally characterized by right lower abdominal pain that is continuous but accompanied by paroxysmal worsening, muscle guarding, and rebound tenderness; appendicitis is one type of what TCM calls intestinal abscess. TCM holds that intestinal abscess arises when the patient's diet is irregular, he is subjected to raging anger, anxiety, and brooding, or falls and runs about, causing the transportation and transformation function of the stomach and intestines to fail, and damp-heat evil toxin to internally congest the intestines. Hence the key to treatment is to clear and disinhibit damp-heat.
The unusual feature of this formula is the extraordinarily large dose of Diyu; few physicians use such a large amount of a single herb. Diyu is the dried root of Sanguisorba officinalis, a plant of the Rosaceae. TCM holds that it is bitter and sour in flavor, slightly cold in nature, and enters the liver, stomach, and large intestine channels. It has the actions of cooling blood and stopping bleeding, and resolving toxin and engendering flesh (healing sores). It is indicated for hematemesis, epistaxis, vomiting of blood, hematuria, hematochezia, hemorrhoidal bleeding, metrorrhagia, and menorrhagia due to blood-heat, as well as for scalds, burns, eczema, and skin ulceration. From the TCM viewpoint, Diyu chiefly clears heat from the blood aspect of the lower burner and has an astringent action. The large and small intestine belong to the lower burner, so using Diyu to treat intestinal abscess is perfectly fitting.
Modern pharmacology has confirmed that Diyu has hemostatic, anti-inflammatory, antibacterial, anticancer, antiemetic, hepatoprotective, and renoprotective effects, and can also raise white blood cells. Diyu's hemostatic action is chiefly due to the strong inhibitory effect of its tannins and polyphenols on plasmin. Diyu has a certain inhibitory effect on cancers such as cervical cancer, liver cancer, and intestinal cancer.
Judging from the usage and dosage of this formula, Diyu Yin is mainly used for intestinal abscess presenting with hematochezia. Not only is the amount of Diyu large, but the amount of licorice is also large (the licorice here is raw licorice, Sheng Gancao), and honeysuckle is also somewhat larger than the usual dose. This is therefore a strongly acting formula for acute abdominal pain and hematochezia, and when used it should produce an immediate effect.
The LD50 of Diyu is 1.60-2.5 g/kg. The dose of Diyu in this formula is very large, so it should not be used for a prolonged period. Using such a large amount briefly in an emergency is permissible, but if the patient's intestinal abscess is a chronic condition, one should not use the medicine long-term in this way.