TCM for Acute Emergencies: Resolving Severe Intestinal Obstruction in Ten Hours

I have long regretted that TCM is called the "slow physician." People say TCM is slow only because they have not encountered cases of TCM treating acute emergencies. In clinical practice I often encounter emergencies, and they are quickly resolved, saving patients at the very moment between life and death.

There was once a patient with advanced cervical cancer at a local hospital in Sichuan, whose abdominal pain from intestinal obstruction was tearing her apart. The hospital gave various laxatives, all without effect. She was then transferred to a Grade-A tertiary hospital in Chengdu, where doctors tried various bowel-relieving methods, also without effect. The patient had had no bowel movement for many days; the intestinal obstruction was compounded by cancer pain, and she wished for death. Various painkillers she took had no analgesic effect. The attending physician demanded surgery, but the patient was in very poor condition and did not want surgery; she appealed to me remotely.

Based on her condition, I prescribed a modified Zengye Chengqi Tang (Fluid-Increasing Order-the-Qi Decoction), with a heavy dose of rhubarb. The formula was as follows:

Scrophularia (Xuanshen) 30 g, rehmannia raw (Shengdi) 24 g, Ophiopogon (Maidong) 24 g, Angelica sinensis (Danggui) 12 g, white peony (Baishao) 12 g, raw rhubarb (Dahuang) 30 g (added later), mirabilite (Mangxiao) 30 g (taken in two divided doses, infused).

I instructed the patient to decoct the medicine and divide it into two portions; take one first and observe for 12 hours. If ineffective, take the other; once effective, stop and switch to another formula to continue treatment.

About ten hours after taking the medicine, the patient had three bowel movements; the abdominal pain was greatly relieved, and the cancer pain had basically disappeared.

Thereafter I added relevant anti-cancer herbs on the basis of Zengye Tang to continue treating her. All her symptoms eased, her strength returned, and she was discharged home.

In this formula I used a heavy dose of rhubarb, up to 30 g. In TCM rhubarb is called "the General" because of its fierce force. Rhubarb excels at resolving emergencies, but many doctors find rhubarb ineffective when treating emergencies — because when they should use rhubarb heavily, they dare not. The ancients had a saying: "Ginseng killing a man is no crime; rhubarb saving a man earns no merit." Patients also like tonics such as ginseng; if they die taking tonics, they do not blame ginseng, only their own severe illness. Yet even when rhubarb cures them, they still fear it, because rhubarb is a harsh purgative. Delighted by tonics and frightened by purgatives — with such a mindset, it is hard to cure disease.

However, when using medicines like rhubarb, one must mind the measure. TCM emphasizes "stop once the disease is addressed" (zhongbing ji zhi): when using such harsh medicines, once the emergency is resolved, one should stop or reduce the dose, switching to a formula that harms the body less. Otherwise, going beyond what is needed backfires.