Zhishi Daozhi Pill for Food Accumulation Transforming into Heat

Zhishi Daozhi Wan (Immature Bitter Orange Stagnation-Directing Pill) is an empirical formula of Li Dongyuan, one of the four great masters of the Jin-Yuan dynasty. It is recorded in Li Dongyuan's Neiwaishang Bianhuo Lun (Discrimination of the Confusion between Internal and External Damage). Its composition: Dahuang (Rhei Radix et Rhizoma) ten liang; Shenqu (Mass-fermented Medicinal Leaven, fried) and Zhishi (Aurantii Fructus immaturus, stir-fried with wheat bran), each five qian; Huanglian (Coptidis Rhizoma, wine-fried), Huangqin (Scutellariae Radix, wine-fried), Baizhu (Atractylodis macrocephalae Rhizoma, earth-fried) and Fuling (Poria), each three qian; Zexie (Alismatis Rhizoma) two qian. Grind all the herbs into powder and form into pills; take 1-2 qian (3-6 g) each time.

This formula drains heat and unblocks stagnation, fortifies the spleen and drains dampness. It treats epigastric and abdominal pain and fullness, poor appetite, constipation, and tenesmus in dysentery caused by food accumulation and internal obstruction of damp-heat. It is also commonly used for infants who refuse milk or food, with abdominal distension, dry mouth and irritability, feverishness on the abdominal wall, hot palms and soles, restlessness and irritability, restless sleep at night, dark urine, foul or constipated stools, a red tongue with yellow greasy coating, a slippery rapid pulse, and purple finger venules. This whole cluster of problems is basically caused by indigestion or by digestive disturbance due to pathogenic gastrointestinal infection.

In Zhishi Daozhi Wan, Dahuang is used in the heaviest dose, more than twenty times that of the other herbs. Dahuang is a common TCM purgative whose main action is catharsis; TCM holds that it also drains heat. Food accumulation or gastrointestinal infection usually produces the patient's subjective sense of internal heat—dry mouth, constipation, foul stools, or frequent bowel movements with a feeling of incomplete evacuation; tongue examination shows a thick yellow greasy coating. TCM regards this as Yangming fu-excess or Yangming damp-heat syndrome; following the treatment principles of "reduce excess by draining" and "treat overflowing by unblocking," the formula should be built around the purgative Dahuang.

In this formula, Zhishi assists Dahuang in dissipating distension; Shenqu aids digestion; Huangqin and Huanglian clear heat; Baizhu and Fuling fortify the spleen and drain dampness; Zexie drains heat and percolates dampness. The composition thus addresses all of the patient's concurrent signs. The Tangtou Gejue (Verses on Classical Formulas) sets the verse for this formula: "Zhishi Daozhi leads with Dahuang, / Qin, Lian, Qu, Zhu, Fuling and Bo; / Zexie with steamed cake paste-pills taken, / it repels warmth, heat and accumulation. / If tenesmus accompanies qi stagnation, / add Muxiang and Binglang for Muxiang Daozhi." Zhishi Daozhi Wan also has modifications: if qi stagnation is marked, add Muxiang (Aucklandiae Radix) and Binglang (Arecae Semen).

Many patent-medicine factories produce Zhishi Daozhi Wan; it is an over-the-counter (OTC) drug available in pharmacies, so patients need not make it themselves. If taking pills is inconvenient, it may be prescribed as a decoction: Shengdahuang (raw rhubarb) 5-30 g (added near the end), Zhishi 3 g, Jiao Shenqu (scorched leaven) 3 g, Fuling 2 g, Baizhu 2 g, Huangqin 2 g, Huanglian 2 g, Zexie 1.5 g.

Zhishi Daozhi Wan may be used short-term but not long-term; prolonged use may cause habitual constipation. If symptoms recur after 3-7 days and medication must continue, the patient should see a physician for a fresh prescription.