Da Cheng Qi Tang — Major Order the Qi Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions

What is Da Cheng Qi Tang?

Da Cheng Qi Tang (“Major Order the Qi Decoction”) is the most powerful purgative formula in the Chinese pharmacopoeia and one of the most famous of the Shang Han Lun formulas. It treats the Yangming Fu (organ) syndrome — the dramatic clinical pattern of Heat that has descended from the Yangming channel level into the Stomach and Intestines and locked up the bowels. The formula combines Da Huang (purgative), Mang Xiao (softens hardened stool), Hou Po (moves Qi) and Zhi Shi (breaks accumulation) to forcefully purge accumulated Heat and stool.

Da Cheng Qi Tang TCM pattern

Prescribed for Yangming Fu syndrome (Heat lodged in the Stomach and Intestines), characterised by: severe constipation, abdominal fullness, distension and pain that resists pressure, tidal fever in the late afternoon, profuse sweating, delirious speech, a thick yellow dry or burnt tongue coat, and a deep, full, forceful pulse.

Key herbs

1. Da Huang (rhubarb) — 12 g; the chief herb; drains Heat and unblocks the bowels
2. Mang Xiao (mirabilite) — 9 g; softens hardened stool
3. Hou Po (magnolia bark) — 15 g; moves Qi and reduces fullness
4. Zhi Shi (bitter orange immature fruit) — 12 g; breaks Qi stagnation and disperses accumulation

Formula actions

1. Vigorously purges Heat accumulation
2. Unblocks the bowels
3. Reduces severe abdominal fullness and pain

Conditions treated

1. Acute severe constipation with Heat signs
2. Post-operative ileus (paralytic ileus) — substantial modern research
3. Acute pancreatitis (specialist hospital use)
4. Bowel obstruction without strangulation (specialist use)
5. Acute febrile illness with constipation locking up the Heat
6. Severe constipation in stroke recovery

Cautions

This is a powerful purgative formula and must be prescribed and supervised by an experienced practitioner. Contraindicated in pregnancy and breastfeeding. Contraindicated in Qi or Yin deficiency, Spleen Yang deficiency, and in the elderly or debilitated. Must not be used for chronic functional constipation — Ma Zi Ren Wan is the appropriate gentler formula. Always consult a qualified Chinese herbalist registered with the RCHM. Online herbal consultations are available.