Muxiang Binglang Wan (Aucklandia and Areca Pill) for Damp-Heat Constipation
Muxiang Binglang Wan is an empirical formula of Zhang Zihe, the founder of the purgation school among the Four Great Masters of the Jin-Yuan dynasties. This formula is recorded in Zhang Zihe's Rumen Shiqin (Confucians' Duties to Their Parents). Muxiang Binglang Wan is composed of: Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Qingpi (Citri Reticulatae Viride Pericarpium), Chenpi (Citri Reticulatae Pericarpium), Ezhu (Curcumae Rhizoma), Huanglian (Coptidis Rhizoma), and Zhiqiao (Aurantii Fructus), 1 liang each (30 g); Huangbai (Phellodendri Cortex) and Dahuang (Rhei Radix et Rhizoma), 3 liang each (90 g); Chao Xiangfu (stir-fried Cyperi Rhizoma) and Qianniu (Pharbitidis Semen), 4 liang each (120 g). Grind all the above into fine powder and make into pills.
If the patient has undigested food stagnation, Jiao Sanxian and Jineijin can be added to this formula to aid digestion; if abdominal distension and pain are marked, add Yuanhu, Xiangfu, Houpo, and Sharen to move qi and stop pain; for pediatric food stagnation, add Heye and Chen Jingmi to protect zheng qi.
Take 1-2 qian (3-6 g) each time, twice daily, washed down with warm water or ginger decoction after meals. This formula can also be used as a decoction; when decocting, adults use one-tenth of the above dose. Because this is an empirical formula with outstanding efficacy, physicians of all dynasties have used it widely; even now, manufactured patent medicine Muxiang Binglang Wan is sold on the market, and patients can buy and use it directly.
Traditional TCM holds that this formula has the actions of moving qi and guiding stagnation, draining heat and relaxing the bowels. It is indicated for the damp-heat accumulation pattern. Clinically, whenever there is epigastric and abdominal fullness and pain, oppressive discomfort, difficult urination and defecation, or red-white dysentery with tenesmus, yellow greasy tongue coating, and a forceful excess pulse, this formula can be used. The accumulation pattern treated by this formula is an excess pattern in TCM; although deficiency patterns may also have constipation, this formula should be used cautiously to avoid damaging zheng qi. Nowadays this formula is mostly used for acute and chronic gastroenteritis, bacillary dysentery, acute and chronic cholecystitis, pediatric food stagnation, intestinal obstruction, etc. belonging to the damp-heat accumulation pattern. Terminal cancer patients with ascites and obstruction of urination and defecation may use it temporarily, but it should not be used for long.
Zhang Zihe's formula is a typical purgative-approach prescription. Zhang Zihe was known in the world for being good at purging; he was skilled at and dared to use large doses of purgative herbs such as Dahuang and Qianniuzi. These herbs often bring unexpected effects, but also have certain side effects. When using Zhang Zihe's formulas, we must make accurate syndrome differentiation; they can be used for excess pathogen patterns, but should be used cautiously for zheng deficiency.
Even if using this formula achieves temporary effect, it should not be used for long. Because the rhubarb quinones in Dahuang have a two-way effect: they can relieve constipation, but long-term use can cause more severe habitual constipation. When using this formula to treat constipation, follow the principle of "stop when the disease is cured"; after constipation is relieved, stop the medicine or switch to Muxiang Shunqi Wan, Maren Wan, or other such medicines for follow-up care.