This is the classic four ingredient formulation devised by Zhang Jie-bing (a.k.a. Zhang Jing-yue), which appears in the collection of his writings, €˜Complete Works of (Zhang) Jing-yue€™ (jing yue quan shu), 1624. It is designed as a €˜branch€™, or secondary aspect, (biao) treatment for painful diarrhoea that occurs due to Liver Qi invasion of the Spleen, hence the formula€™s name: €˜Important Formula for Painful Diarrhoea€™ (tong xie yao fang).
Stress or prolonged emotional strain generally leads to Liver Qi constraint. In patients with pre-existing deficiency of the Spleen, this scenario readily leads to invasion of the Spleen by the Liver Qi, which counterflows €˜transversely€™. When the Spleen Qi is impaired, diarrhoea results due to two processes: a) retention of Damp and b) loss of the astringing, or containing, action of the Qi. Because the Liver fails to maintain the normal smooth and even flow of the Qi in the gastrointestinal tract, the diarrhoea is accompanied by spasmodic abdominal pain. As mentioned above, this formula focuses on alleviating the diarrhoea as well as the pain. Therefore, in order to address the underlying causes, it may be prescribed in combination with an appropriate Spleen Qi tonifying or a Liver-Spleen harmonising formula, as described above.
The synergistic actions of the herbs are as follows:
- Paeonia root (bai shao): calms the Liver and harmonises the Liver and Spleen, alleviate pain
- Atractylodes macrocephala, rhizome (bai zhu): tonifies the Spleen Qi and dries Damp
- Saposhnikovia root (fang feng): directs the actions of the other ingredients to the Liver and Spleen, promotes the ascending Qi movement of the middle Jiao to strengthen the Spleen and alleviate diarrhoea.
- Citrus fruit peel (chen pi): Harmonises the Spleen and Stomach, resolves Damp.
