Shi Zao Tang — Ten-Jujube Decoction
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Overview
Shi Zao Tang — the “Ten-Jujube Decoction” — is from Zhang Zhongjing’s Shang Han Lun. It is a heroic, powerful formula for severe water excess (xuan yin) — large-volume pleural effusion, ascites, or severe peripheral edema where milder approaches have failed. The name comes from the use of ten jujubes (Da Zao) cooked into the formula to soften and protect the digestion against the harsh purgatives Gan Sui, Yuan Hua and Da Ji.
This formula is rarely used in modern outpatient practice. Severe effusions are managed with diuretics, paracentesis, thoracocentesis or treatment of the underlying disease. It is included here for completeness and historical reference.
I do not generally prescribe this formula in outpatient practice.
TCM pattern
Shi Zao Tang is prescribed for severe water-Qi excess in the chest, hypochondrium or abdomen:
- Severe pleural effusion — chest pain on movement, shortness of breath
- Severe ascites
- Severe generalised edema
- Hypochondriac pain
- Shortness of breath worse on lying flat
- Strong constitution still preserved
- Tongue — slippery white coat
- Pulse — deep, wiry, forceful
Key herbs
- Gan Sui (Euphorbia kansui) — powerfully purges water; toxic
- Yuan Hua (Daphne genkwa) — purges water; toxic
- Da Ji (Knoxia or Euphorbia pekinensis) — purges water; toxic
- Da Zao (ten large jujubes) — protects Stomach Qi from the harsh herbs
Formula actions
- Powerfully drives out excess water
- Protects the middle burner from injury during purgation
Conditions treated
- Severe pleural effusion — historical/hospital use only
- Severe ascites — historical/hospital use only
- Refractory edema in strong constitutions — rare modern indication
Cautions
Heroic, harsh, potentially dangerous formula. Used only by very experienced practitioners in TCM hospital settings, never in outpatient self-prescribed care.
Contains three toxic herbs (Gan Sui, Yuan Hua, Da Ji). Use only properly processed preparations.
Strictly contraindicated in pregnancy, the elderly, weak constitutions, Qi or Yin deficiency, and during acute illness or fever.
Severe pleural effusion and ascites require conventional medical investigation and management. Chinese herbs are an adjunct at most.
This page is for educational reference.
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