Notes on This Category

• Da huang, Lu hui, and Fan xie ye all contain anthraquinone glycosides which make them stimulant laxatives (as well as having some antibiotic effect) – increasing peristalsis. (The common Western herbal purgatives Cascara sagrada and Frangula are also stimulants containing anthraquinones.)
• Other common laxatives include citrus seed extracts and castor oil (the latter is a strong stimulant). Psyllium seed husk (a Plantago species), flax seed meal, and Pang da hai, when eaten, are high-fiber bulk-forming laxatives, which retain water and stimulate peristalsis by forming a mass in the intestines.
• All but the fiber (bulk-forming) laxatives are generally contraindicated in pregnancy.
• The herbs in this category are commonly combined with:
A. Herbs to clear heat and toxicity, promote Qi and blood circulation.
B. Herbs to warm the interior, when there is constipation due to Yang deficiency (e.g. Da huang + Fu zi).
C. Herbs that release the exterior, when there is an EPI associated.
D. Herbs that support Zhen Qi, when the patient has a weak constitution.

Chief Applications:
1. Dry and hard stool due to excess heat or fire in the large intestine.
2. High fever, coma, delirium due to blockage of the heart by excess heat.
3. Headache, red and painful eyes, toothache, hemoptysis, hematemesis due to flare up of fire from the liver, Lungs, stomach, or large intestine.
4. Tong Yin Tong Yang: Purgation when there is leakage (incontinence) due to blockage.

Da Huang – Rhubarb root and rhizome – Rheum – “Big Yellow”

Nature: bitter, cold

Enters: Stomach, Large Intestine, Liver, Heart, Spleen

Actions: Clears heat, reduces fire; eliminates toxicity; promotes blood circulation, dispels blood stasis; drains accumulation and stagnation; drains damp-heat; drains heat from the blood, clears heat obstructing the blood level.

• Any accumulation or stagnation of heat or damp-heat in the large intestine, including Yangming stage invasion: high fever, profuse sweating, thirst, constipation, abdominal distention and pain, delirium, yellow tongue coat, full pulse.
• Stomach fire: hematemesis, epistaxis.
• Blood stasis: amenorrhea, lochioschesis, masses, trauma, hemorrhage, fixed pain, stasis due to intestinal abscess.
• Damp-heat: jaundice, painful urination, acute hot dysentery.
• Heat and toxicity: carbuncles, boils, furuncles, burns. Use internally and/or topically.
• Blood in the stool due to bleeding hemorrhoids or heat accumulation in the intestines.
• Excess heat obstructing the blood level: fever, hot, swollen, painful eyes, or fire toxin sores.
• Antineoplastic, antifungal, and antibacterial effects.
• May lower cholesterol.
• Also for schistosomiasis.
• Topical: for dermatitis, stomatitis, oral ulcers/canker sores.
• As a paste with vinegar on K-1 for abdominal distention. Change every 2 hours.
• Local application of a decoction has been shown to be effective in the treatment of stomatitis, oral ulcers, and folliculitis, especially those caused by Staphylococcus aureus.
• Ecthyma: a powder made of Da huang and Gan cao, used with a multilayered soybean plaster, was applied in 12 cases of ecthyma of up to 13 years duration. All cases healed within 1-4 weeks.
• A 1g dose has a mild effect to stimulate the appetite.
Da huang’s purgative effect takes 6-8 hours.
Da huang has astringent tannin which has a constipating effect that outweighs the purgative effect when taken in small doses (<0.3g).
• For strong purgation, cook only 5 minutes. The longer the cook time, the milder the purgative effect.
• The wine or vinegar treated form has a stronger effect of promoting blood circulation, and is a milder purgative.
• To stop bleeding, use the charred form.
• The alcohol-prepared form can direct to the face.
• When using Da huang, the sweat and urine may be notably yellow.
• Contraindicated for nursing mothers because components are excreted in breast milk.
• One of four herbs in Essiac tea, a cancer formula.
• Anti-inflammatory: a COX inhibitor
Li: “Dissolves fat” – for obesity, high cholesterol, etc. (including with Dan shen, Shan zha, San Qi).
K&R: Metal and wood excess.
• Metal: constipation, dyspepsia, dysentery.
Wood: biliary dyskinesia, gallstones, high cholesterol, blood stasis.
• Anti-inflammatory.
• Has bacteriacidal action against Bacerioides fragilis, which has been found in large quantities in the gallbladders of patients with hepatic or gallbladder disease.
BII: Reduces bleeding of duodenal and gastric ulcers.
Yoga: Amla-vetasa: P, K-; V+
• Purges Pitta, Ama, and stagnation.
DY: To moderate Da huang’s purgative effect, combine it with Gan cao.
• Can be used for any type of constipation, when combined with other herbs specific for the pattern.
• Up to 3g Da huang is lightly purgative and stimulates digestion. Over 3g, the higher the dose, the purgative its effect is. There is a wide variability in the degree of sensitivity of patients to the purgative effects of Da huang. Profuse diarrhea can occur with only 3g in one patient, while constipation can resist a 12g dose in another patient.
• Wine mix-fried Da huang is very slightly purgative. Carbonized Da huang is not purgative.
• With Fu zi to warm the interior, precipitate accumulation of cold, and evacuate the stools. For constipation, abdominal pain, fear of cold, and cold limbs due to accumulation of internal full cold. (Da Huang Fu Zi Tang).
When this pair is combined with Xi xin, it has shown an interesting action in the treatment of cold-damp Bi or impediment with Yang deficiency and blood stasis (use wine mix-fried Da huang for this) as well as for Bi with an accumulation of heat in the stomach and intestines with persistent constipation.
• It is noteworthy to mention that some practitioners believe that small doses (1-3g) of Da huang can have supplementing effects and that this medicinal can be integrated into any formula that supplements the middle burner. However, this is probably an indirect effect. As it is said, the bowels function when they are freely flowing. The spleen cannot be fortified and healthy if the stomach and intestines are not free flowing. In addition, when the spleen becomes weak and, therefore, loses its control over transportation and transformation, the stomach typically becomes hot due to accumulation and depression. Therefore, a small amount of Da huang can address this accumulation and heat even if the main symptoms are those of spleen deficiency and there is no marked constipation.
• With Mang xiao for mutual reinforcement, to effectively precipitate full heat and internal accumulation, and free the flow of stools. (Dose of each: up to 15g) For indications such as:
– 1. Constipation with dry, hard stools and abdominal pain which worsens with pressure due to heat accumulation in the Yangming bowels. (Da Cheng Qi Tang)
– 2. Constipation with dry, hard stools, high fever, delirium and mental confusion, and dry, yellow tongue fur due to full heat in the Yangming bowels. (Da Cheng Qi Tang)
– 3. Chronic or severe constipation due to heat.
MLT: For burns (not open sores) soak Da huang in vinegar for 1-3 days and apply locally.
• Use the charred form for diarrhea and to stop bleeding.
PFGC: Enters the blood layer, cracks all forms of stagnant blood. Since its Qi is fragrant, it can also enter the Qi layer – therefore, in small doses, Da huang can regulate Qi and treat Qi stagnation pain.
• Purges all kinds of masses and accumulations.
• Can treat mania by opening the epigastric region and resolving phlegm-heat. Use up to 60g when the pulse is clearly excess.
• Its fragrant orifice-opening effect can disinhibit urination.
• Can also clear heat in the upper Jiao – for all pain in the eyes and oral cavity.
• Descends stomach heat and “entices stomach Qi to move downwards” – excellent for hematemesis.
• Can “drain the old and generate the new.”
Hsu: Stimulates bile and pancreatic secretions; broad antibacterial; anti-carcinogenic effect.
JC: (“Turkey Rhubarb”) Cathartic (aperient to brisk purgative, depending on dosage), hepatic, cholagogue, astringent, tonic, stomachic, antibilious, sialogogue, vulnerary, anthelmintic, peristaltic.
• Given in small doses, it is a valuable stomach tonic, increasing saliva and gastric juices, improving the appetite, promoting the action of the liver and the flow of bile (without astringing the intestines), and facilitating absorption throughout the system.
• Increases circulation in the glands by the GI tract and increases peristalsis by stimulating the muscular layer of the bowel.
• In larger doses (2-3g), it produces copious yellow, pultaceous stools in 6-8 hours, with considerable hepatic stimulation and some griping (although the larger doses may produce severe griping, the herb will never inflame the digestive mucous membrane).
• Highly esteemed as a laxative tonic for children and infants because of the milk-like quality of its action. It acts chiefly on the duodenum, and generally does not clog or produce an after-constipation. The tonic and astringent action following evacuation makes it a valuable remedy for diarrhea due to irritating matter in the bowel – it removes the irritating substance, its astringent properties check the diarrhea, and then it tones and corrects the accompanying atonic indigestion.
• Particularly useful for hemorrhoids with constipation, atonic dyspepsia, infantile digestive and intestinal disorders, and both constipation and diarrhea.

Dose: 3-12g

Fan Xie Ye – Senna leaf – Cassia angustifolia or C. acutifolia – “Purgative Leaf of the Foreigners”

Nature: sweet, bitter, cold

Enters: Large Intestine

Actions: Purges accumulation and stagnation.

• Excess heat in the large intestine: constipation.
• Do not cook too long (over 10 minutes) or at too high a temperature – just add to water at 95°-100° C and let it steep. Water temperatures under 75° C will not be hot enough to extract the purgative constituents of this herb. Cooking over 1 hour will completely eliminate any purgative properties.
• Doses over 10g may cause nausea, abdominal cramps, and vomiting (can be combined with Huo xiang to prevent these side effects).
Fan xie ye’s purgative effect takes 2-6 hours.
• Sources conflict on Fan xie ye’s strength and nature:
Liu: Milder purgative than Da huang.
Li: Stronger purgative than Da huang.
BII: Probably the best-tolerated laxative.
MLT: Can cause griping – combine with a warming herb to counteract this side effect (e.g. Sheng jiang, Chen pi).
K&R: Metal yang, water yang.
• Inhibits resorption of water from the colon.
• Contraindicated with intestinal inflammation, pelvic congestion, or pregnancy.
JC: Cathartic (pods: laxative; leaflets: simple purgative), slight stimulant, antibilious, anti-periodic, tonic.
• A somewhat prompt cathartic that acts on nearly the entire intestinal tract, especially the colon. Suitable for chronic constipation. Acts locally on the intestine wall, increasing peristalsis and secretions, to produce copious yellow stools. Does not constipate afterwards.
• The leaves cause griping and flatulence (the pods do not), and the odor is nauseous to many persons. The griping and nausea may be alleviated by adding some corrective herb, such as: cloves, ginger, cinnamon, coriander, fennel, manna, etc. Often given with licorice.
• Two main varieties, Alexandrian or Nubian senna (Cassia acutifolia, C. senna, C. lenitive, C. officinalis, C. aethiopica) and East Indian or Tinnevelly senna, are used. The former is preferred by most herbalists since it is milder, but equally certain in its action.
• Should not be used when there is an inflamed condition of the GI tract.
• Shortly after administration (2-30 minutes) it may dye the urine reddish.
IBIS: Drug interactions:
• Sennosides aggravate nephropathy from analgesics associated with dehydration (DeSmet).
• Decrease in absorption of oral drugs due to decrease in bowel transit time (DeSmet).
• Aggravates loss of potassium associated with use of diuretics (DeSmet).
• Overuse or misuse can cause potassium loss leading to increased toxicity of cardiac glycosides (Wichtl, DeSmet) such as those in Adonis, Convallaria, Urginea, (Brinker, DeSmet) Helleborus, Strophanthus, and Digitalis (Brinker).

Dose: 1.5-3g for mild purgation. 5-10g for strong purgation.

Lu Hui – Aloe (dried concentrate) – A. vera or A. ferox

Nature: bitter, cold

Enters: Liver, Large Intestine, Stomach

Actions: Clears liver heat; kills parasites (especially roundworms) and strengthens the stomach; purges accumulation and stagnation; drains fire.

• Heat accumulation (liver and/or large intestine): constipation, dizziness, headache, tinnitus, irritability, fever. Also used for chronic constipation.
• Roundworms. Also for ringworm.
• Childhood nutritional impairment, especially when due to roundworms: abdominal pain, sallow face, thin muscles.
• Stronger than Da huang, but can be mild when dosed appropriately.
• Very bitter. Often encapsulated.
• As effective in enema form as when taken orally.
Liu: Less likely to cause griping than Da huang.
Hsu: Low doses are a cholagogue, stimulate intestinal peristalsis.
• High doses induce abdominal pain and congestion of the pelvic cavity.
• Anti-carcinogenic effect.
• Aloe ulcin inhibits histamine synthesis.
IBIS: Note: The leaf gel, commonly consumed as a cleansing juice preparation, is a different product. (McGuffin, p.7).
• Affinities: intestines, skin.
• Actions: laxative on lower gastrointestinal (slow acting 10-15 hours), can also be a purgative; cathartic; bitter tonic, stomachic, hepatic; vermifuge/ anthelmintic; emmenagogue; vulnerary, demulcent, and emollient.
• Dosage: tincture: 1 – 4 mL. resin [Lu hui]: 100 – 300 mg.
• Therapy: atonic constipation; burns; to increase menstrual flow; insect bites; asthma.
• Toxicity varies between different species and varieties of Aloe; barbaloin can be very griping (especially in dried form) and cause severe intestinal irritation; Aloe vera [Lu hui], which has very little, if any, barbaloin, is usually considered non-toxic.
• Contraindicated in pregnancy and cases of menorrhagia or metrorrhagia; also in patients with gastrointestinal inflammation, irritable plethoric conditions and hemorrhoids; not to be used by patients with chronic constipation (Felter and Lloyd, pp. 151-152; Morton, pp. 47-50; U.S. Dispensatory, pp. 46-50).
• Produces catharsis in nursing child (Morton, pp. 47-50).
• May cause or potentiate kidney irritation (Brooks).
• Contraindicated in children younger than 12 due to depletion of electrolytes and water (De Smet).
• Extended use of more than 8-10 days may cause loss of peristalsis from intestinal smooth muscle and mesenteric plexi damage (De Smet).
• Drug interactions: Aloe can cause potassium loss which may lead to increased toxicity of cardiac glycosides such as those in Adonis, Convallaria, Urginea, Helleborus, Strophanthus, and Digitalis (De Smet; Wichtl). Aloe can reduce the absorption of oral drugs and increases potassium loss caused by diuretics (De Smet).

Dose: 0.3-3g (usually taken directly as powder or in capsules)
Aloe in various forms (fresh gel, extract, powder):
BII: Cancer: contains a potent immunostimulant polysaccharide – acemannan – especially effective for leukemia, but also should be considered for: HIV, bronchial asthma, diabetes mellitus, immunodepression.
• May have an anti-ulcerative effect on the GI tract.
Yoga: Kumari: A young girl/virgin, called so because it imparts the energy of youth and brings about the renewal of the female nature.
• Bitter, astringent, pungent, sweet/cooling/sweet.
• VPK= (gel). The powder, except in very low doses, will aggravate Vata.
• Alterative, bitter tonic, rejuvenative, emmenagogue, purgative, vulnerary.
• Regulates sugar and fat metabolism.
• Tonifies all Agnis. Reduces Pitta.
• Fever, constipation, obesity, inflammatory skin diseases, swollen glands, conjunctivitis, bursitis, jaundice, hepatitis, enlarged liver or spleen, herpes, venereal disease, amenorrhea, dysmenorrhea, menopause, vaginitis, tumors, intestinal worms.
• The powder is a strong purgative. Caution: take with a carminative (turmeric, rose, etc.).
DH: For a dry person/constitution. Doctrine of signatures: Aloe retains moisture, even in extremely dry environments.

Mang Xiao – Mirabilite – Sodium Sulfate – Glauber’s Salt (Na2SO4)

Nature: salty, bitter, cold

Enters: Stomach, Large Intestine

Actions: Softens masses; clears heat; moistens dryness; purges stagnation and accumulation; reduces swelling.


• Excess heat in the large intestine and stomach: constipation (only when the stool is dry and hard).
• Heat: painful, swollen, ulcerated mouth or sore throat, canker sores, red, swollen, painful eyes, carbuncles, swellings, skin lesions, breast swellings – yang type mastitis.
• Use large doses (carefully) to purge the intestines of toxicity for the treatment of all cancers.
• Purgative effect usually takes 4-6 hours.
• Should not be cooked – add to the strained decoction.
• Drink large quantities of fluids when taking this substance.
DY: Drains fire; disperses swelling, stops pain, disperses food accumulation (external use).
• With Da huang for mutual reinforcement, to effectively precipitate full heat and internal accumulation, and free the flow of stools. For specific indications and notes, see Da huang in this category.
• With Ji nei jin to strongly and effectively soften hardness, disperse accumulation, clear heat, and transform stones. For renal, urethral, or bladder lithiasis. Neither substance should be cooked. For greatest efficacy, the two herbs should be ground to a powder (6-10g Ji nei jin and 3-10g Mang xiao) and taken, 6g at a time, twice daily, dissolved in hot water.

Dose: 3-9g

Xuan Ming Fen: a purer form of sodium sulfate
• Less effective as a purgative than Mang xiao, but superior in topical preparations for ulcers of the oral cavity / canker sores.